CPG-301 EM Planning Guide for Special Needs Populations ......4 INTERIM - Comprehensive Preparedness Guide 301 August 2008 1 III. DEFINING “SPECIAL 2 NEEDS” 3 4 Emergency management

Comprehensive Preparedness Guide (CPG) 301 1 2 3 4 5 6 7 8 9 10 11 12

Interim Emergency 13

Management Planning Guide 14

for Special Needs 15

Populations 16 17 Federal Emergency Management Agency and 18

DHS Office for Civil Rights and Civil Liberties 19 20 Version 1.0 (August 15, 2008) 21 22 23 24

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

21 (Intentionally Blank) 22

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August 2008 INTERIM - Comprehensive Preparedness Guide 301 iii

CONTENTS 1

2 3 I. ABOUT THIS PLANNING GUIDE ........................................................................................1 4 5 II. INTRODUCTION ....................................................................................................................1 6 7 III. DEFINING “SPECIAL NEEDS” .............................................................................................4 8 9 IV. PERSONAL PREPAREDNESS ...............................................................................................6 10 11 V. PLANNING CONSIDERATIONS ..........................................................................................7 12 13

A. PLANNING NETWORKS AND ROLES .......................................................................................8 14 B. ASSESSMENTS AND REGISTRIES ..........................................................................................13 15 C. EMERGENCY COMMUNICATION AND PUBLIC INFORMATION ...............................................18 16 D. SHELTERING AND MASS CARE ............................................................................................25 17 E. EVACUATION ......................................................................................................................28 18 F. TRANSPORTATION ...............................................................................................................33 19 G. HUMAN SERVICES AND MEDICAL MANAGEMENT ..............................................................37 20 H. CONGREGATE SETTINGS .....................................................................................................40 21 I. RECOVERY ...........................................................................................................................42 22 J. TRAINING AND EXERCISES ...................................................................................................44 23

24 APPENDICES ..............................................................................................................................47 25 26

A. STATE, TERRITORIAL, TRIBAL, AND LOCAL COMMUNITY PREPAREDNESS RESOURCES ......49 27 B. PERSONAL PREPAREDNESS RESOURCES ..............................................................................52 28 C. EXAMPLES OF NATIONAL ORGANIZATIONS HAVING RESOURCES FOR 29 SPECIAL NEEDS AND EMERGENCY PREPAREDNESS ............................................................55 30 D. HIPAA PRIVACY RULE AND DISCLOSURES IN EMERGENCY SITUATIONS ...........................57 31 E. SPECIAL NEEDS REGISTRY INFORMATION ...........................................................................59 32 F. CIVIL RIGHTS CONSIDERATIONS RELATED TO SPECIAL NEEDS PLANNING .........................61 33 G. GLOSSARY ..........................................................................................................................71 34

iv INTERIM - Comprehensive Preparedness Guide 301 August 2008

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August 2008 INTERIM - Comprehensive Preparedness Guide 301 1

I. ABOUT THIS PLANNING 1

GUIDE 2

3

This guide is intended as a tool for State, Territorial, Tribal, and Local emergency 4 managers in the development of emergency operations plans (EOPs) that are 5 inclusive of the entire population of a jurisdiction of any size. It provides 6 recommendations for planning for special needs populations. The 7 recommendations can be implemented now, no matter how much, or how little a 8 jurisdiction has completed up to this point. Creating “the perfect” plan before 9 undertaking steps toward implementing these strategies is not feasible. An 10 emergency manager’s main concern will be to include all essential information in 11 the EOP, developing immediate capabilities, and building capacity over time. 12

This guide offers scalable recommendations to meet the needs of different 13 jurisdictions based on factors such as size, risks, and hazards. A town with a 14 population of 2,000 citizens, for example, will plan differently for special needs 15 populations than will an entire State or urban area. Furthermore, each 16 jurisdiction must decide for itself which responsibilities will be handled at the 17 State level and which responsibilities will be handled at the Local level. 18

The information in this document is universal in its application and tied to national 19 planning policies and guidance such as the National Response Framework 20 (NRF), National Incident Management System (NIMS), and Comprehensive 21 Preparedness Guide 101 (currently under development). 22

II. INTRODUCTION 23

BACKGROUND 24

Throughout the history of emergency management planning, considerations for 25 special needs populations have often been inadequate. From the 1930s, when 26 disaster response was ad hoc and largely focused on the repair of damaged 27 infrastructure, through the present day, emergency management culture of 28 “readiness,” special needs populations were often given insufficient 29 consideration. This fact was evident in 2003 during the California wildfires1 and 30 when Hurricane Katrina devastated the Gulf Coast in 2005. During these events, 31

1 The Impact of Southern California Wildfires on People with Disabilities, California State Independent Living Council, April 2004.

2 INTERIM - Comprehensive Preparedness Guide 301 August 2008

some individuals with special needs did not receive appropriate warning, were 1 unable to access shelters, or went without medical intervention. During the 2006 2 Nationwide Plan Review, a sample of emergency management plans was 3 reviewed by subject-matter experts (SMEs) on disability and aging. The review 4 confirmed that emergency plans from various regions in the United States 5 continue to overlook these populations. The Nationwide Plan Review Phase 2 6 Report concluded that “substantial improvement is necessary to integrate people 7 with disabilities in emergency planning and readiness.” 8

Numerous “lessons learned” reports that followed Hurricane Katrina also pointed 9 out there is a large segment of the U.S. population who may not be able to 10 successfully plan for, and respond to, an emergency with resources typically 11 accessible to the general population. The current general population is one that 12 is diverse, aging, and focused on maintaining independence as long as possible. 13 The popularity of living situations that provide an “as needed” level of care in the 14 least restrictive manner is fast becoming the norm. Consideration should 15 therefore be given to people who may be able to function independently under 16 normal situations, but who may need assistance in an emergency situation. 17

For example, it is estimated that about 13 million individuals age 50 or older in 18 the United States will need evacuation assistance, and about half of these 19 individuals will require such assistance from someone outside of their 20 household.2 There are well over 1 million people in the United States receiving 21 home healthcare according to 2000 data cited by the National Center for Health 22 Care Statistics. Populations such as these should be considered when 23 emergency plans are developed to accurately assess the resources needed to 24 adequately respond when a disaster strikes. The 2000 Census reported that 18 25 percent of those surveyed speak a language other than English at home. This 26 highlights the need to ensure the effectiveness of emergency communications. 27 Populations described as “transportation disadvantaged”—those who do not 28 have access to a personal vehicle or are precluded from driving—may also 29 require assistance during emergencies. The 2000 Census reports that in the top-30 ten car-less cities, between 29 and 56 percent of the households are without a 31 vehicle. These examples serve to demonstrate community emergency planning 32 should go beyond traditional considerations. For a list of resources available for 33 emergency planning, see Appendix A. 34

During the Nationwide Plan Review, emergency managers consistently 35 requested technical assistance in identifying and incorporating special needs 36 populations into emergency planning. As described later in this planning guide, 37 defining the term “special needs” is a critical initial step in the planning process. 38 The Federal Government introduced, within the National Response Framework 39 (NRF), a definition of special needs populations that State, Territorial, Tribal, and 40 Local governments may adopt for use in their EOP development. It is important 41 to note that though this terminology may appear ambiguous, it is well established 42

2 We Can Do Better; Lessons Learned for Protecting Older Persons in Disaster, AARP, 2006.


in the emergency management vocabulary and when clearly defined, 1 strengthens the planning process. 2

Although it is recognized that significant emergency planning should be done for 3 incarcerated populations, these groups cannot be integrated into general 4 population planning. Individuals in correctional settings are institutionalized to 5 protect other members of society; people who are institutionalized in health 6 related settings are there for their own protection and well being. Emergency 7 management planning for incarcerated populations requires additional 8 consideration such as law enforcement and coordination between emergency 9 managers, the Department of Corrections, and prison superintendents to ensure 10 safety of the prisoners and the public. For these reasons, incarcerated 11 populations are not included in the NRF definition of “special needs,” which is the 12 same definition used in this planning guide. 13

NATIONAL PERSPECTIVE 14

At the national level, several key policy and planning initiatives are currently in 15 development. These efforts are aimed at ensuring the health and safety of 16 individuals with special needs. 17

• The NRF includes guidance for defining the term “special needs 18 populations,” and special needs considerations have been woven 19 into the appropriate operational protocols. 20

• In the revision of NIMS, emphasis is being placed on the accessibility 21 of emergency communications, effective outreach to special needs 22 populations, and the addition of a special needs advisor within the 23 incident command structure. 24

• Pursuant to the 2007 Homeland Security Appropriations Act, the 25 Federal Emergency Management Agency (FEMA), in partnership with 26 the U.S. Department of Homeland Security (DHS) Office for Civil 27 Rights and Civil Liberties and an interagency work group, developed a 28 guidance document, Accommodating Individuals with Disabilities within 29 Disaster Mass Care, Housing, and Human Services. 30

• Homeland Security Grants Program guidance is being reviewed and 31 updated to place greater emphasis on planning for special needs 32 populations within states and urban areas. 33

• DHS’s Comprehensive Preparedness Guide 101 (formerly known as 34 State and Local Guide 101) reinforces the importance of special needs 35 considerations and provides a bridge to the details offered in this 36 planning guide. 37


III. DEFINING “SPECIAL 1

NEEDS” 2

3

Emergency management takes into consideration planning for the safety of every 4 person in the community during and following a disaster. Taking into 5 consideration populations historically considered “vulnerable,” “at risk,” or 6 “special needs” ultimately improves the overall community’s post-disaster 7 sustainability. 8

Before drafting emergency plans, it is recommended that a statewide definition 9 for the term “special needs” be developed and used to guide State, Territorial, 10 Tribal, and Local jurisdictions in the planning process. A consistent use of 11 terminology will result in improved communication and coordination of resources 12 across State, Territorial, Tribal, and Local entities. 13

The NRF definition for “special needs” provides a function-based approach for 14 planning and seeks to establish a flexible framework that addresses a broad set 15 of common function-based needs irrespective of specific diagnosis, statuses, or 16 labels (e.g., children, the elderly, transportation disadvantaged).3 In other words, 17 this function-based definition reflects the capabilities of the individual, not the 18 condition or label. Governments that choose to align their language to the NRF 19 definition will improve inter-government communication during an incident. The 20 definition of “special needs populations” as it appears in the NRF is as follows: 21

Populations whose members may have additional needs before, during, and after 22 an incident in functional areas, including but not limited to: 23

• Maintaining independence 24

• Communication 25

• Transportation 26

• Supervision 27

• Medical care 28

3 The concept of a function-based approach to defining special needs populations has been developed by June Isaacson Kailes. See Kailes, J. and Enders, A. in “Moving Beyond ‘Special Needs’ A Function-Based Framework for Emergency management Planning,” Journal of Disability Policy Studies, Vol/No. 44/2007/pp. 230-237.


Individuals in need of additional response assistance may include those who 1 have disabilities; who live in institutionalized settings; who are elderly; who are 2 children; who are from diverse cultures; who have limited English proficiency; or 3 who are non-English speaking; or who are transportation disadvantaged. 4

At first glance, it may appear that each of the above groups (and a 5 disproportionately large percentage of the population) is automatically classified 6 as having special needs, but this is not the case. The definition indicates these 7 groups may often include individuals who have special needs and, in the event of 8 an emergency, may need additional assistance or specialized resources. For 9 example, in a city like New York where less than half of all households own a car, 10 transportation-dependence is not necessarily a “special need.” A special need in 11 this instance is an inability to access the transportation alternatives defined by 12 the EOP. It is important to remember that special needs populations have needs 13 that extend beyond those of the general population. 14

The definition focuses on the following function-based aspects: 15

• Maintaining Independence – Individuals requiring support to be 16 independent in daily activities may lose this support during an 17 emergency or a disaster. Such support may include consumable 18 medical supplies (diapers, formula, bandages, ostomy supplies, etc.), 19 durable medical equipment (wheelchairs, walkers, scooters, etc.), 20 service animals, and/or attendants or caregivers. Supplying needed 21 support to these individuals will enable them to maintain their pre-22 disaster level of independence. 23

• Communication – Individuals who have limitations that interfere with 24 the receipt of and response to information will need that information 25 provided in methods they can understand and use. They may not be 26 able to hear verbal announcements, see directional signs, or 27 understand how to get assistance due to hearing, vision, speech, 28 cognitive, or intellectual limitations, and/or limited English proficiency. 29

• Transportation – Individuals who cannot drive or who do not have a 30 vehicle may require transportation support for successful evacuation. 31 This support may include accessible vehicles (e.g., lift-equipped or 32 vehicles suitable for transporting individuals who use oxygen) or 33 information about how and where to access mass transportation during 34 an evacuation. 35

• Supervision – Before, during, and after an emergency individuals may 36 lose the support of caregivers, family, or friends or may be unable to 37 cope in a new environment (particularly if they have dementia, 38 Alzheimer’s or psychiatric conditions such as schizophrenia or intense 39 anxiety). If separated from their caregivers, young children may be 40


unable to identify themselves; and when in danger, they may lack the 1 cognitive ability to assess the situation and react appropriately. 2

• Medical Care – Individuals who are not self-sufficient or who do not 3 have adequate support from caregivers, family, or friends may need 4 assistance with: managing unstable, terminal or contagious conditions 5 that require observation and ongoing treatment; managing intravenous 6 therapy, tube feeding, and vital signs; receiving dialysis, oxygen, and 7 suction administration; managing wounds; and operating power-8 dependent equipment to sustain life. These individuals require support 9 of trained medical professionals. 10

The above examples illustrate function-based needs that may exist within the 11 community. 12

13

IV. PERSONAL PREPAREDNESS 14

15

Public education is one component of an overall personal preparedness strategy. 16 Encouraging individuals with special needs to take responsibility for their own 17 safety and security will benefit emergency managers and responders during an 18 incident. Preparedness material should stress the message of personal 19 preparedness planning and be conveyed via advertising (e.g., Public Service 20 Announcements (PSAs) on television and/or radio, billboards, etc.), outreach 21 materials (e.g., brochures, fact sheets, etc.), and through special needs networks 22 within the community. 23

The message of personal preparedness should include information on where 24 individuals can access tools and guidance in creating a personal plan. There are 25 many cost-free sources of personal preparedness information for the elderly, 26 individuals with disabilities, children, and individuals with limited English 27 proficiency. For information on personal preparedness measures recommended 28 by the Ready Campaign, American Red Cross and others, see Appendix B. 29

The message of personal preparedness is particularly important for those who 30 care for children, the elderly, or individuals with disabilities. Parents or 31 caregivers should be encouraged to: 32

• Keep an information form (such as the Emergency Information Form, 33 found at http://www.aap.org/advocacy/epquesansw.htm) with the 34 individual at all times. This form should include information on all 35 diagnoses, medications and dosages, developmental level, physician 36


and specialist names and contact information, vital signs when the 1 individual is well, and emergency contact information. 2

• Contact the utility companies to inform them there is someone with a 3 disability or with health needs in the home. This action is especially 4 critical if the individual is dependent on an uninterrupted power supply 5 for life-sustaining equipment such as a ventilator. 6

• Notify local emergency medical services and, where possible, ask 7 them to place the individual’s information in the computer-aided 8 dispatch system. 9

• Create a personal support network of people who can assist in the 10 event of an emergency. Develop a personal preparedness plan with 11 those people. Compile an emergency go-kit. For individuals who are 12 unable to plan for themselves or their family members, caregivers 13 should coordinate with nongovernmental organizations (NGOs), such 14 as Meals on Wheels and Voluntary Organizations Active in Disaster 15 (VOADs), and local government through their Citizen Corps Council to 16 provide assistance. 17

18

V. PLANNING 19

CONSIDERATIONS 20

21

Planning for special needs populations is fundamental to the development of an 22 EOP and each jurisdiction has distinct populations for which to plan. For 23 example, some jurisdictions may need to focus their efforts on developing 24 communication plans for neighborhoods of diverse cultures, while others will 25 need to prepare for a large elderly population with no transportation. Effective 26 planning involves engaging special needs partners throughout the process and 27 building special needs considerations into the plans themselves. Strategies to 28 maximize the abilities of these individuals not only provide for their needs, they 29 also maximize limited resources during a disaster. 30

Developing emergency plans that consider all populations addresses certain core 31 elements. In particular, emergency managers should: 32

• Know the demographic profile of the community and understand the 33 type of assistance that may be required by various populations during 34 an emergency. 35


• Establish a rigorous public education program with an emphasis on 1 personal preparedness. Make sure information is available in 2 accessible formats and languages to reach the entire community. 3

• Collaborate with stakeholders (such as the local Citizen Corps Council, 4 if one exists) and with representatives of special needs populations. 5 No agency should work in isolation, and the emergency manager must 6 establish partnerships to better understand community resources and 7 prevent each agency from “reinventing the wheel.” 8

• Ensure the plans are “living documents” and are updated with a 9 predetermined frequency and after any major event. 10

• Establish mutual-aid agreements and memorandums of understanding 11 with neighboring communities that can provide additional emergency 12 resources. 13

• Communicate the emergency plan to response and community 14 stakeholders. 15

• Ensure all stakeholders are trained on the plan. 16

• Ensure all exercises include members of special needs populations. 17

There are two effective strategies to incorporate provisions for special needs 18 populations into EOPs. It is critical to integrate special needs considerations 19 throughout each of the EOP components (e.g., within each ESF, if the jurisdiction 20 is using that format). Integrating provisions for various function-based needs into 21 each ESF ensures special needs considerations are part of overall planning. In 22 addition, some jurisdictions find it beneficial to develop an annex devoted 23 specifically to special needs populations to simplify the communication of special 24 needs planning elements with stakeholders. 25

If a State, Territorial, Tribal, or Local government is unprepared, public 26 confidence and community sustainability may be compromised. Effective 27 planning is an ongoing process, and to be successful, plans must receive regular 28 periodic review and be updated to reflect demographic shifts, changes in service 29 levels, and new or increased hazard risks. The following sections provide points 30 for consideration based on lessons learned and best practices identified by an 31 array of governmental and nongovernmental subject matter experts (SMEs). 32

A. PLANNING NETWORKS AND ROLES 33

Jurisdictions with the most success at planning for special needs populations 34 have established relationships with a variety of stakeholders. No single agency 35 can provide all of the expertise needed for comprehensive planning. An inclusive 36 approach should use expertise from the individuals, organizations, and agencies 37


discussed in this section. These groups and individuals should be involved in all 1 stages of the planning process, including the initial assessment of plan purpose, 2 situational needs and assumptions, and the development of a draft concept of 3 operations. Members of this planning network should assess how their efforts 4 can be coordinated. 5

The planning process should also focus on improving the understanding of 6 agency-based assets, capabilities, and limitations as well as identifying 7 opportunities for improvement and cooperation. Agencies that participate in an 8 integrated planning process should be encouraged to work together on an 9 ongoing basis to develop a joint response. They should also be encouraged to 10 develop mutual-aid agreements and memorandums of understanding regarding 11 procedures for sharing resources during emergency events. 12

PLANNING NETWORKS 13

Consistent with the principles within the Comprehensive Preparedness Guide 14 101, emergency managers should prioritize the development of relationships that 15 will result in an effective planning network. The following entities may be 16 instrumental partners in developing the planning network: 17

• State, Territorial, Tribal, or Local emergency management agencies. 18

• Citizen Corps Councils and Program Partners (Community Emergency 19 Response Teams (CERT), Medical Reserve Corps (MRC), Fire Corps, 20 Volunteers in Police Service (VIPS) and Neighborhood Watch). 21

• Local Emergency Planning Committees (LEPCs). 22

• Local first responders (i.e., police, fire, EMT). 23

• Metropolitan Medical Response System (MMRS), 24

• Local government and nongovernment disability agencies. 25

• Developmental disabilities networks and service providers. 26

• Protection and advocacy agencies. 27

• Departments of aging and social services. 28

• Hospitals and hospices. 29

• Culturally or language-based community groups. 30

• VOADs such as the American Red Cross and The Salvation Army. 31


• Health departments (State, Territorial, Tribal, and Local as 1 appropriate). 2

• Departments of education. 3

• Health and human services agencies (including child welfare). 4

• 2-1-1 Human Services Information and Referral Services 5

• HUD or other rent-subsidized multi-family complexes. 6

• HUD or otherwise subsidized non-licensed supervised living facilities. 7

• Nursing homes. 8

• Media 9

• Home healthcare organizations. 10

• Medical service and equipment providers (including durable medical 11 equipment providers). 12

• Pharmaceutical providers. 13

• Agencies on alcohol and drug addiction. 14

• Job and family service agencies. 15

• Vocational rehabilitation agencies. 16

• Independent living centers. 17

• Behavioral health and mental health agencies. 18

• Commissions on the deaf and hard of hearing and the blind and 19 visually impaired. 20

• Governor’s committees on individuals with special needs and/or 21 disabilities (as applicable). 22

• Translation and interpretation service agencies. 23

• Transportation service providers (including those with accessible 24 vehicles). 25

• Utility providers. 26

• Colleges and universities. 27


• Faith-based organizations. 1

• Schools. 2

• Child care facilities (both center-based and home-based). 3

• Parents. 4

• Veterinary resources. 5

• Individuals with special needs. 6

In addition to these groups, there are national organizations that have expertise 7 in emergency planning with specific segments of special needs populations. For 8 a sample list of these national organizations, see Appendix C. For information on 9 how to select the right individuals for this task, please read Why and How to 10 Include People with Disabilities in Your Planning Process? at 11 http://www.nobodyleftbehind2.org/findings/why_and_how_to_include_all.shtml. 12

As a whole, the responsibilities of agencies, groups, and individuals participating 13 in the planning network include: 14

• Promoting and sustaining independence and self-determination of 15 people in evacuation and sheltering situations. 16

• Maintaining and upholding human and civil rights policies, procedures, 17 laws, and regulations. 18

• Providing access to resources to support people’s needs. 19

• Ensuring programs and services are accessible to, accommodate, and 20 are inclusive of people with functional limitations. 21

• Documenting and promoting the use of proven best practices. 22

• Promoting the establishment of mutual-aid agreements that integrate 23 Local agency resources into emergency plans and response 24 strategies. 25

• Monitoring shelter and evacuation activity, temporary housing, and 26 other emergency and disaster assistance centers. 27

• Assessing shelter, evacuation, and housing intake forms and 28 questions. 29


• Assisting in the training of evacuation, shelter, and emergency housing 1 agency personnel to effectively address and respond to special needs 2 populations. 3

PLANNING ROLES 4

STATE, TERRITORIAL, TRIBAL, OR LOCAL EMERGENCY MANAGER 5

The emergency manager is responsible for developing a partnership with the 6 lead coordinating agency for special needs considerations. The emergency 7 manager should work closely with the lead agency (see below) to identify what 8 resources will be needed for special needs populations during an emergency, as 9 well as the support services that are available within the community. If the need 10 for services and resources is greater than the availability, the emergency 11 manager is responsible for managing the process of augmenting available 12 resources and/or identifying alternative solutions. 13

LEAD AGENCY FOR COORDINATING SPECIAL NEEDS CONSIDERATIONS 14

A common theme among emergency management professionals is the need for 15 better coordination between jurisdictions and within special needs communities, 16 as well as stronger special needs planning networks. It is highly recommended 17 that one agency be designated as the lead for coordinating special needs 18 planning throughout the government entity. Some jurisdictions have selected 19 their social services agency to assume the leadership role. 20

SPECIAL NEEDS ADVISORY COMMITTEE 21

It is recommended that jurisdictions draw from the Planning Network to establish 22 a special needs advisory committee. The committee should consist of individuals 23 with special needs who reside in the jurisdiction, as well as representatives from 24 the Local emergency management agency, disability and special needs provider 25 organizations, advocacy groups, and Local government agencies. 26

Each jurisdiction can shape the committee to meet its particular needs. The 27 committee can be a stand-alone group of people, connected with the Local 28 disaster planning group (i.e. LEPC), or sponsored by the local Citizen Corps 29 Council. The special needs advisory committee should meet as frequently as 30 necessary to enable committee members to become familiar with one another, 31 exchange information, and coordinate their efforts. Committee meetings also 32 provide a forum for presentations and for the review of relevant reports. 33

SPECIAL NEEDS ADVISOR 34

Increasingly, emergency management agencies are hiring permanent staff 35 and/or contracting SMEs to provide focused special needs expertise for the 36 emergency planning process. Similarly, many emergency managers recognize 37


the importance of enhancing their capacity to respond to special needs 1 populations by establishing a special needs advisor staff role within the incident 2 command structure. This individual functions within the command structure (e.g., 3 the immediate staff of the Incident Commander, the Planning Section, and/or the 4 Operations Section). 5

B. ASSESSMENTS AND REGISTRIES 6

ASSESSMENTS 7

Assessments and registries are sometimes mistakenly considered the same 8 when in fact they are different. To begin planning, State, Territorial, Tribal, and 9 Local governments should have an accurate assessment—an informed estimate 10 of the number and types of individuals with special needs residing in the 11 community. Emergency planners should base their assessments on lists and 12 information collected from multiple relevant sources wherein individuals with 13 special needs are represented, such as: 14

• U.S. Census data 15

• Social services listings (dialysis centers, Meals on Wheels, etc.) 16

• Paratransit providers 17

• Bureau of Motor Vehicles (accessible parking permit holders) 18

• Health departments (State, Territorial, Tribal, or Local as applicable) 19

• Utility providers 20

• Job access services 21

• Congregate settings 22

– Group homes 23

– Nursing homes 24

– Long-term care facilities 25

– Assistive living units 26

– Summer camps 27

– Residential schools 28

– Hospice facilities 29


• Schools (especially those with a significant number of students with 1 disabilities or students enrolled in English as Second Language 2 programs) 3

• County emergency alert list serves 4

• Medicaid 5

• Hospitals 6

• Day care centers (for children or senior citizens) 7

• Places of worship 8

• Homeless shelters 9

State, Territorial, Tribal and Local officials may need more information about the 10 impact of the Health Insurance Portability and Accountability Act’s (HIPAA’s) 11 Privacy Rule on their ability to obtain data from agencies and private groups 12 serving special needs communities. The Privacy Rule controls the use and 13 disclosure of protected health information held by “covered entities” (healthcare 14 providers who conduct certain transactions electronically, healthcare 15 clearinghouses, and health plans). The Privacy Rule permits covered entities to 16 disclose information for public health and certain other purposes. Transportation 17 and social service providers are not likely to be subject to the Privacy Rule and 18 may be permitted to disclose the number of individuals they serve. For more 19 information on how the Privacy Rule applies to disclosures during emergency 20 situations, see Appendix D. 21

If emergency managers compile the numbers from various lists, often referred to 22 as the “list of lists” concept, they will have an estimate of the number of 23 individuals residing in their communities, which will benefit planning for sufficient 24 transportation and sheltering. There may be duplication of numbers, where one 25 person is on multiple lists. On the other hand, some individuals who require 26 assistance during an emergency will not use these service providers or agencies. 27 Together these lists can provide raw numbers vital to understanding the 28 magnitude of the community’s requirements. Emergency managers should also 29 gather as much information as possible regarding the types of services these 30 individuals require, so emergency staff can be adequately trained and resource 31 needs can be met. 32

Again, the key to the “list of lists” is cultivating relationships between agencies 33 before the disaster. It is also essential to keep these lists updated, conducting 34 new assessments at least annually. 35


REGISTRIES OF INDIVIDUALS 1

A registry is a database of individuals who voluntarily sign up and meet the 2 eligibility requirements for receiving emergency response services based on a 3 need (the criteria for which should be established by the State, Territorial, Tribal, 4 or Local jurisdiction). Because registries are voluntary, not everyone who 5 requires assistance during an emergency will enroll. People may be reluctant to 6 sign up for assistance, in part, because they do not want to disclose their 7 personal data for the following reasons: 8

• They fear their financial assets will be taken. 9

• They fear legal consequences (in the case of undocumented workers). 10

• They think the privacy of their medical information will not be protected, 11 making them targets of crime and fraud. 12

• Their function-based or medical needs are new, temporary, or incurred 13 as a result of the disaster. 14

• They do not believe they have a need for assistance. 15

Registries therefore do not identify every individual who needs assistance during 16 an emergency and should not be used as a master tool for first responders. 17 Furthermore, participation in a special needs registry program does not take the 18 place of personal preparedness. All special needs registry participants—and 19 everyone in general—should have a personal preparedness plan. 20

In addition, it is recommended that registries be reserved for individuals living in 21 their own homes and not in congregate settings (such as residential healthcare 22 facilities). These facilities are responsible for developing emergency plans and 23 providing for their residents. Rather than registering facility residents, 24 jurisdictions should coordinate with each facility as an entire entity, working to 25 understand the numbers and needs of the people they serve. 26

LIABILITY AND EXPECTATIONS 27

It is important to ensure the expectations of the registrants match the types of 28 emergency services offered. Some people believe that entering their name and 29 information into a registry means the government will automatically provide 30 transportation or sheltering for them in the event of an emergency. The 31 jurisdiction responsible for the registry should be clear in communicating 32 limitations of liability for the jurisdiction that sponsors the registry, as well as 33 limitations in service that might be present under various emergency situations. 34

As mentioned, potential registrants may be hesitant to give their personal 35 information to the government. It is imperative the confidentiality of the 36


registrant be strictly protected. The identities of the registrants should not be 1 shared with anyone but emergency response personnel on a need-to-know 2 basis. Additionally, registrants should be informed that the process is completely 3 voluntary, and the information provided to the government will not be 4 disseminated or used for anything other than emergency assistance. State, 5 Territorial, Tribal and Local officials are advised to consult with legal counsel 6 regarding the applicability of HIPAA and State and Local laws and regulations 7 that govern the confidentiality of information maintained in the registry. 8

SCALABILITY 9

The smaller the community, the more effective the registry. It is also possible for 10 a registry to be effective without serving the entire breadth of the population as 11 defined by a function-based model. A jurisdiction can target a registry to a 12 segment or segments of the population considered to be at higher risk. For 13 example, a jurisdiction might begin by registering only those individuals who will 14 require transportation assistance during an emergency. 15

REGISTRY MAINTENANCE 16

The long-term maintenance of a special needs registry is an important 17 consideration in planning a registry system. The needs and whereabouts of 18 people are constantly changing; therefore, keeping a registry updated with 19 accurate information is both continuous and costly (on-going funding is 20 essential). The costs and resources necessary to keep the registry current 21 should be factored into a jurisdiction’s decision about establishing such a system. 22 It is recommended that appropriate funding should be provided to a designated 23 agency to manage and update the registry at least once a year. 24

The registry update and management process (method, frequency, etc.) that a 25 jurisdiction chooses should be dictated by the type of population covered by the 26 registry, the mobility of the population, and the frequency of hazards that confront 27 the jurisdiction. Individuals should register annually and should be periodically 28 contacted to determine if they still require the registry’s services. Some 29 communities have asked their Citizen Corps volunteers to help gather registry 30 information by going door-to-door to the houses of individuals who identify 31 themselves as having special needs. 32

OTHER CONSIDERATIONS 33

Although registries can provide important information about a community’s 34 special needs populations, the following concerns arise and should be kept in 35 mind: 36

• Providing individuals on the registry with emergency information is not 37 enough. Jurisdictions should have a method for reaching everyone in 38


the community before, or during, an emergency. This concept will be 1 discussed at greater length in the Emergency Communication and 2 Public Information section of this guide. 3

• Back-up power sources are needed to access the registry during a 4 power outage. 5

• Registries do not include individuals who develop disabilities or health 6 or mental health conditions as a result of the emergency itself. 7

• Many individuals register using their home address, but these people 8 might be at school, work, or elsewhere during the day (making the 9 home address of little use should an emergency occur). Registries 10 that seek to provide emergency services should include a question 11 about the location of the registrant during daytime hours. 12

(See Appendix E for more detail on considerations related to developing a 13 special needs registry.) 14

GEOGRAPHIC INFORMATION SYSTEM 15

A Geographic Information System (GIS) can be of great value to State, 16 Territorial, Tribal, and Local governments for coordinating and mapping disaster 17 resources across agency and jurisdictional boundaries. As one scholar puts it, “It 18 is too late to collect data when the water rises and the earth shakes.”4 19

Demographic information related to natural population clusters (e.g., cultural, 20 language, seniors, or children) or registry information entered into a database 21 management program can provide the means to quickly assess populations 22 impacted by a disaster. For example, computer-generated maps (with icons 23 identifying specific demographic or resource information) allow the operator to 24 view all data collected for that site. In addition, each potential hazard site can be 25 mapped. In the event of a hazardous material release from a fixed facility, for 26 example, the GIS operator can quickly create a plume model of the surrounding 27 vicinity to determine the vulnerability of schools, day care centers, senior centers, 28 group homes, etc. 29

Efforts in Alabama provide illustration of how GIS technology can be used in 30 planning for special needs populations. Argonne National Laboratory developed 31 the Special Population Planner (SPP) in cooperation with the Alabama 32 Emergency Management Agency and six Alabama counties. The SPP is the first 33 GIS-based software tool designed to facilitate emergency planning for special 34 needs populations. The SPP enables users to map communities, facilities, and 35

4 Using Geographic Information System Technology to Improve Emergency Management and Disaster Response for People with Disabilities. Alexandra Enders and Zachary Brandt, Journal of Disability Policy Studies, Vol. 17/No. 4/2007/pp.223–229.


households where persons with special needs reside relative to response assets 1 and hazard scenarios. Expandable for broader planning applications, the 2 SPP initially includes tools to accomplish five main activities: 3

• Creating and updating a voluntary special needs population registry of 4 key personal data. 5

• Creating and updating area GIS information, including assigning map 6 locations to registered persons based on street addresses. 7

• Automatically generating reports and maps. 8

• Analyzing data in the context of planning zones and scenarios for 9 preparing response plans. 10

• Organizing emergency response plans for quick retrieval and updates. 11

With this information emergency managers, law enforcement officials, 12 firefighters, and transportation officers can efficiently identify individuals needing 13 assistance during an evacuation, facilitate steps to shelter in place, and take 14 other response actions as needed. The SPP (including its user guide) may be 15 downloaded as a free open-source application from the following website: 16 http://sourceforge.net/projects/spc-pop-planner/. 17

C. EMERGENCY COMMUNICATION AND PUBLIC INFORMATION 18

Communication is the cornerstone of successful planning and response. 19 Emergency communication, as well as preparedness and mitigation information, 20 should be accessible for people with disabilities, limited English proficiency, and 21 to members of diverse cultures. People who are deaf, deaf-blind, or hard of 22 hearing cannot hear radio, television, sirens, or other audible alerts. Similarly 23 individuals who are blind or who have low vision may not be aware of visual 24 cues, such as flashing lights and scrolling emergency information on television. 25 Emergency plans should not rely on a single source of general notification for the 26 community—multiple methods are necessary. 27

Emergency communication involves two closely interrelated aspects—delivery 28 mechanisms and content messaging. The following sections provide points for 29 consideration related to these two areas. 30

DELIVERY MECHANISMS 31

EMERGENCY ALERT SYSTEM 32

The national Emergency Alert System (EAS) was designed to ensure that if one 33 link in the dissemination of alert information is broken, the public has alternate 34 sources for warning. EAS provides capacity for: 35


• Broadcast radio, television, and cable systems to send and receive 1 emergency information quickly and automatically, even if their facilities 2 are unattended. 3

• Authorized Local and State personnel to distribute important 4 emergency information. 5

• The State emergency manager to send out public warnings through 6 major radio stations in his or her State. 7

• Direct monitoring of the National Weather Service for Local weather 8 and other emergency alerts. Local broadcast stations, cable systems, 9 and other EAS participants can then rebroadcast the alerts, providing 10 an almost immediate relay of Local emergency messages to the public. 11

• Automatic interruption of regular programming and relaying of the 12 emergency messages in languages used by the EAS participant. 13

EAS network participants are mandated to broadcast national EAS alerts. 14 However, use of EAS for State and Local broadcasting is encouraged, but not 15 mandatory. 16

EAS Impact on Special Needs Populations 17 In October 2005, the Federal Communications Commission (FCC) expanded the 18 EAS rules to require EAS participation by digital television broadcasters, digital 19 cable television providers, digital broadcast radio, Digital Audio Radio Service, 20 and Direct Broadcast Satellite systems. The FCC’s EAS rules require that EAS 21 provide access to people with disabilities by providing both visual and aural 22 alerts. Under the rules, a visual EAS alert does not have to be an exact 23 transcription of an audio alert, but must be “any method of visual presentation 24 which results in a legible message conveying the essential emergency 25 information.” In the future, EAS will be based on a Common Alerting Protocol 26 that will transmit EAS messages so they can be received by equipment in voice, 27 text, data, or video formats. 28

Many communities also use the NOAA Tone-Alert or Specific Area Message 29 Encoder to provide warning for any community emergency. These inexpensive 30 receivers issue alerts for emergency messages only, increasing the probability of 31 a message being noticed. 32

NON-EAS ALERT BROADCASTS 33

Not all broadcasts of emergency information trigger the EAS. Accordingly, the 34 FCC adopted separate requirements to meet the needs of persons with 35 disabilities in cases where radio and television broadcasters and cable service 36 providers provide non-EAS emergency announcements and alerts. In 47 Code 37 of Federal Regulations (CFR) § 79.2, the FCC requires that any information 38


intended to further the protection of life, health, safety, or property, such as 1 immediate weather situations, civil disorders, evacuation orders, school closings, 2 relief assistance, etc., be accessible to persons with disabilities. These rules 3 apply to all Local broadcasters, cable operators, and satellite television services.5 4

There are no exemptions to FCC rules regarding accessibility of emergency 5 broadcast information. Television and broadcast stations must provide 6 emergency public information in a visual format, such as open captions, scrolls, 7 or even hand-lettered signs, accessible to persons with hearing disabilities. The 8 critical details must also be provided in an aural format, meaning that spoken 9 information must be accessible to persons with vision disabilities. If the 10 emergency information is provided in the video portion of programming that is not 11 a regularly scheduled newscast or a newscast that interrupts regular 12 programming, this information must be accompanied by an aural tone. If crawls 13 or scrolls are provided during regular programming, an aural tone is required to 14 indicate to persons who are blind or who have low vision that emergency 15 information is being provided. Additionally, if television stations run a text 16 message crawl across the bottom of the screen, they should ensure it does not 17 interfere with the area reserved for closed captioning. Camera operators and 18 editors need to include the sign language interpreter in the picture if one is 19 interpreting next to the emergency spokesperson. (Title IV of the Americans with 20 Disabilities Act also requires closed captioning of federally funded public service 21 announcements.) 22

9-1-1 EMERGENCY CALLING 23

9-1-1 emergency calling, as well as reverse 9-1-1, should be accessible to 24 persons with hearing, speech, and vision disabilities. Currently, persons with 25 hearing or speech disabilities can use a teletypewriter (TTY) or 26 telecommunications device for the deaf (TDD) to directly call 9-1-1 through 27 wireline phones and analog wireless phones. TTYs and TDDs are machines that 28 allow people with hearing or speech disabilities to communicate over the phone 29 in text using a keyboard and viewing screen. The FCC encourages TTY users to 30 call 9-1-1 directly for immediate service, as all 9-1-1 Public Safety Answering 31

5 The FCC’s Enforcement Bureau has enforced these requirements by issuing Notices of Apparent Liability for Forfeiture (NAL) regarding video programming distributors. These NALs cite numerous apparent violations of the FCC’s Section 79.2 rule in which information broadcast in October 2003, about wildfires throughout southern California was not made accessible via captioning or other visual presentation in timely fashions. Examples of information about this emergency situation that were not made accessible include information on road closures and evacuations, location of emergency shelters, and advisories to viewers on possible health concerns from air pollution caused by the wildfires. These FCC actions were the first in the Commission’s history regarding its accessibility to emergency programming rules, codified at 47 CFR § 79.2. Since that original action, there have been additional NALs filed and two have resulted in consent decrees that provide a valuable set of best practices for television stations to assist them in complying with the requirements for accessibility. See In the Matter of Fox Television Stations, Inc. Licensee of WTTG-TV Washington, DC, Order and Consent Degree, DA 06-2052, 21 FCC Rcd. 13364 (released November 17, 2006).


Points (PSAPs) must be equipped to directly receive TTY calls. If TTY users 1 choose to contact a 9-1-1 PSAP via Telecommunications Relay Service (TRS), 2 the caller may experience delay because the caller’s number must be forwarded 3 to an appropriate PSAP by the TRS center. This feature is automatic for 4 traditional TRS; however, it presents a challenge for the newer Internet-based 5 forms of TRS until PSAPs are upgraded to be Internet-based. 6

Ideally, planners should designate an alternate 9-1-1 PSAP that is more than 200 7 miles away to answer calls when the primary and secondary PSAPs are 8 disabled. These back-up PSAPs should be fully equipped and trained to handle 9 calls from deaf and hard-of-hearing individuals, including the many types of 10 telecommunication relay calls. 11

AUTOMATED DIALING PROGRAMS (EMERGENCY TELEPHONE NOTIFICATION) 12

The automatic dialing program allows the delivery of prerecorded messages, 13 which is particularly beneficial in instances where staffing is limited. However, 14 some disadvantages with this notification system are: 15

• Persons may be confused and even frightened if they only hear part of 16 the message. 17

• Many individuals may not understand what the message is saying. 18

• A prerecorded message cannot respond to requests to speak louder or 19 to repeat or clarify a message. 20

Automatic dialing programs are more effective if augmented by a designated 21 person to contact specific, pre-identified individuals. This method also allows the 22 caller to ask the individual for assistance if needed. 23

PHONE TREE 24

Phone trees allow emergency managers to disseminate information to a wide 25 audience with just a few phone calls. Patterned after existing call-down systems, 26 a phone tree can “multiply outreach and response capabilities while minimizing 27 the number of staff needed to activate the tree at any time.”6 A phone tree 28 begins when emergency managers contact “branch managers,” or the top-level 29 contacts (such as residential care facility administrators, utility company officials, 30 staff members of community organizations, senior housing complex managers, 31 or other government officials). These officials and personnel will contact smaller 32 “branches” who will, in turn, contact even smaller “branches.” Emergency 33 managers should be mindful that the phone tree system will not work as well at 34

6 Adapted in part from the National Organization on Disability Emergency Preparedness Initiative, N.O.D. Guide on the Special Needs of People with Disabilities. Page 19.


night, when many of the “branches” do not have personnel at work. This system 1 is built upon planning network resources. 2

TEXT MESSAGING 3

Text messaging provides participants, including deaf and hard-of-hearing 4 individuals, a potentially life-saving tool to receive emergency notification and 5 ongoing updates on an emergency situation. Often referred to as Community 6 Alert Systems, text messaging is used to transmit emergency notifications, 7 updates, and other important information to individuals who register for the 8 service. Registration generally is done via Web-based application and, once 9 established, is available to anyone in the community. Some communities have 10 extended this service to individuals with limited English proficiency as well, 11 providing an option of selecting an alternative language for the message during 12 the sign-up process. Alert types may include life safety, fire, weather, accidents 13 involving utilities or roadways, team activation notifications, or disaster 14 notification such as a terrorist attack. Text messages can appear on computers, 15 PDAs, and pagers. 16

The State of Oklahoma has developed a system called the Oklahoma Weather 17 Alert Remote Notification System (OK-WARN), which alerts citizens with hearing 18 loss to weather hazards and other emergencies. Alerts originate with the NOAA 19 National Weather Service and are transmitted via satellite to software within the 20 Oklahoma Department of Civil Emergency Management’s Paging Alert System. 21 The software condenses the information and sends it to Local paging companies, 22 which, in turn, sends the information to pagers, cell phones, personal digital 23 assistants (PDAs), etc. For more information, visit 24 http://www.nssl.noaa.gov/edu/safety/pagers.html. 25 . 26

E-MAIL NOTIFICATION 27

E-mail may be more reliable when telephone lines, wireline, or wireless systems 28 do not operate or are overloaded during an emergency. The Internet uses 29 shared (rather than dedicated) transmission facilities, so e-mail transmissions are 30 deliverable even during heavy transmission periods, albeit more slowly. 31 Computer users who have dedicated Internet access can generally get through 32 to their e-mail system, although dial-up Internet users may experience some 33 difficulty when dialing their Internet Service Provider (ISP), either because the 34 Local telephone system is congested or all the ISPs lines are busy. E-mail is 35 also useful because the recipient does not have to be available at the same time 36 as the sender and can retrieve messages at his or her convenience. 37

At the same time, even if email is readily accessible, people may not check it 38 regularly or remember to check it for emergency information. As with all other 39 means of communications, email should be used in conjunction with other 40 available methods. 41


WEB-SITES 1

Web-sites that are fully accessible can also be used to provide emergency 2 information to individuals with special needs. Jurisdictions should include 3 information about Web sites as part of their public education campaigns, so 4 people know the Web address to access emergency information. Like email, this 5 method allows the user to access information at his or her convenience. Foreign 6 language content on Web sites should be made easily noticeable to persons with 7 limited English proficiency accessing the site, and the information should be 8 displayed in a simple format. The Web site should be accessible to visitors with 9 a wide range of vision, dexterity and cognitive disabilities. Free on-line tools are 10 available to check the accessibility of the site. 11

DOOR-TO-DOOR WARNING SYSTEMS 12

Door-to-door warning, or neighborhood canvassing, is a last resort option when 13 other modes of communications have failed. It is prudent to begin with 14 congregate settings, where notification of a staff member will benefit a large 15 number of residents. A jurisdiction will need to draw information from its registry, 16 or from utilities and other service providers, to identify individuals living alone. 17 See Section B on Registries to learn more about obtaining this information. 18

If notifying individual residences, first responders should consider the cultural 19 diversity of the neighborhoods. For example, communicating with a non-English 20 speaking population will require translators or responders who speak the 21 language or understand what is considered acceptable interaction. Non-text 22 signs such as pictograms also are useful when communicating with individuals 23 who are deaf or hard of hearing or who do not speak English. Additionally, 24 individuals who are homeless may require personal notification. This method is 25 also most efficient for notifying concentrated populations of homeless persons. 26

ADDITIONAL CONSIDERATIONS 27

In addition to Federal laws, the following communication considerations are 28 important7: 29

• Consider providing emergency messages in languages other than 30 English on public access channels and working cooperatively with non-31 English radio and television stations to provide emergency information. 32

• For the benefit of individuals with cognitive disabilities, the most 33 pertinent information should be repeated frequently using a simple 34 vocabulary. 35

7 Adapted in part from the National Organization on Disability Emergency Preparedness Initiative, N.O.D. Guide on the Special Needs of People with Disabilities. Page 19.


• Not all blind individuals are aware that one of the functions of the 1 audible beeps on television is to signal the text of an emergency alert 2 message and to cue the listener to tune into a radio broadcast for more 3 information. . 4

• Technology used to communicate with special needs populations 5 should be exercised regularly. Deaf, hard-of-hearing, and blind 6 populations can be reached through alternative means. Alternative 7 means include closed captioning, qualified sign language interpreters, 8 Braille, text messaging, TTY, large print, and audio tape. Under Title II 9 of the Americans with Disabilities Act, emergency management 10 agencies must be reachable by alternative means such as TTY or 11 video relay capabilities. 12

• Some communities with high rates of limited English proficiency use 13 bilingual staff or interpreters at radio and television stations to 14 communicate information. 15

• Organizations serving ethnic or senior communities, are ideal sources 16 for promising practices, cooperative collaborations, and resource 17 sharing. 18

• Pictorial representations, where appropriate, can provide quick and 19 easily understood instruction to many individuals within special needs 20 populations, including children, individuals with limited English 21 proficiency, and some individuals with cognitive disabilities. 22

• It is helpful to use a spokesperson who is easily identifiable as 23 representing the organization or population. 24

MESSAGE CONTENT 25

The content of a message is just as important as its effective delivery. It is 26 essential to include special needs individuals, as well as agencies and 27 representatives of each segment of the special needs population, in the message 28 development process. Because of their experience and understanding of 29 pertinent issues, they can advise emergency managers and public information 30 officers on how best to communicate effectively with populations requiring 31 alternate communication. 32

Messages delivered during an emergency should provide specific information 33 about transportation, evacuation, and sheltering locations. Message content 34 should include, when appropriate, incident facts, health risk concerns, pre-35 incident and post-incident preparedness recommendations, and where to access 36 assistance in a format or language that a broad spectrum of the community can 37 understand. Where necessary, the base content of these messages should be 38 composed and translated into other languages in advance (with opportunity for 39


collaboration and input from all interested stakeholders), leaving placeholders to 1 insert the specifics of each emergency situation and the protective actions 2 recommended. 3

D. SHELTERING AND MASS CARE 4

Life safety and the health of individuals are the primary goals of emergency 5 sheltering. It is important to accomplish these goals while simultaneously 6 respecting civil rights. For individuals with special needs in particular, this means 7 focusing on appropriate assistance and integration into the system. 8

Disability civil rights laws require physical accessibility of shelter facilities, 9 effective communication using multiple methods, full access to emergency 10 services, and reasonable modification of programs where needed. In 11 accordance with Title II of the Americans with Disabilities Act (ADA), general 12 population shelters should offer individuals with disabilities the same benefits 13 provided to those without disabilities. These benefits include safety, comfort, 14 food, medical care, and the support of family and friends. For detailed 15 information on the ADA’s application to emergency sheltering, see the guidance 16 issued by the Department of Justice in July 2007. This guidance includes a 17 shelter accessibility assessment tool available at 18 http://www.usdoj.gov/crt/ada//pcatoolkit/chap7shelterchk.htm. In addition, FEMA 19 has issued a Web-based reference guide to Federal civil rights laws and their 20 application to Accommodating Individuals with Disabilities in Mass Care, 21 Housing, and Human Services, available at http://www.fema.gov/oer/reference. 22

General population shelter staff should make appropriate accommodations for 23 individuals with special needs. These accommodations may include physical 24 accessibility, modifications to facilities, pictogram signage language and sign 25 language interpreters, and volunteers to help elderly and/or other individuals who 26 need minimal assistance with daily living activities. Historically, VOADs (such as 27 the American Red Cross) manage general population shelter services following a 28 disaster. However, because no jurisdiction can depend on one source to supply 29 all personnel and resources necessary, emergency managers should draw from 30 the skills and resources within special needs planning networks (discussed in 31 Part A of Section V). 32

Shelter plans should also outline how to obtain resources such as durable 33 medical equipment (i.e., wheelchairs, walkers, and canes), personal hygiene 34 supplies, skilled staff, etc. Children will need items such as diapers, formula, 35 baby food, toys, etc. Special needs advocates can work with emergency 36 managers to secure these resources from the State, Territorial, Tribal, or Local 37 government, NGOs, and the private sector. 38 39 Systems should be in place for managing shelter staff and volunteers, including a 40 process for identifying and training personnel, verifying credentials and screening 41 for security risk. As with triage staff, shelter staff should have access to 42


language assistance services to assist persons with limited English proficiency 1 and individuals who are deaf or hard of hearing. When possible, agreements 2 should be created ahead of time, and critical partnerships and roles should be 3 established between relevant agencies and service providers. 4 5 Specialized Shelters 6 Based on the nature of the emergency and the needs of the community, State, 7 Territorial, Tribal, and Local governments have sometimes established 8 specialized shelters that provide a level of service beyond the general population 9 shelter level of care. Specialized shelters may be co-located within a general 10 population shelter, a unit within a medical shelter, or a stand alone entity. These 11 specialized operations offer assistance to individuals who require intensive 12 assistance with daily life activities and individuals who have needs for on-site 13 professional medical care. Plans, staff, and resources for specialized shelters, 14 even when co-located with a general population shelter, are a State, Territorial, 15 Tribal, or Local government responsibility. Here again, an integrated planning 16 approach for shelter management and resources is essential, and emergency 17 planners should focus on coordinating with special needs planning networks. 18 19 Specialized shelter plans that rely on assistance from accompanying caregivers 20 should qualify the assumption that such help will be forthcoming. Although family 21 caregivers are essential, they will still depend on shelter staff for function-based 22 needs. They may have other family members, such as children, with whom to be 23 concerned. Furthermore, clients may have no family caregiver present, or the 24 family caregivers could have significant medical conditions themselves. 25 26 In support of the NRF, FEMA in collaboration with Federal and nongovernmental 27 partners, is developing the Functional Needs Support Unit (FNSU). Once the 28 program is in place, a FNSU can be deployed as a “plug-in” to a mass-care 29 shelter and, when necessary, can be a stand-alone shelter. Trained and certified 30 shelter staff will be assigned to the FNSU to serve as caregivers and provide the 31 assistance normally supplied by a family member or attendant. Specific 32 information regarding FNSUs and other sheltering considerations will be outlined 33 in a guidance document that is expected for release in 2008. When completed, 34 this document is also intended to serve as a template for developing sheltering 35 plans. 36 37 Individuals needing acute medical care should be taken to medical shelters or 38 hospitals. Consideration should be given to a mechanism for transferring 39 patients to the appropriate location, taking into account the transportation and 40 sheltering needs of their caregiver and/or family members. 41 42


TRIAGE 1

Triage is the method by which individuals are prioritized for assistance and is the 2 key for placing individuals in appropriate shelters. An assessment process 3 should be established by qualified staff to ensure individuals are housed in 4 shelters with an appropriate level of resources. Triage procedures should reflect 5 the importance of placing individuals in shelters that meet their needs in the least 6 restrictive manner possible. As such, triage staff should: 7

• Receive basic training on how to communicate with a wide range of 8 populations. 9

• Have access to language and sign language interpreters as needed to 10 assist limited English proficient populations and deaf or hard-of-hearing 11 individuals. 12

• Have access to medical and behavioral health personnel (registered 13 nurses, doctors, social workers, or other practitioners) who can 14 determine which individuals need medical care. 15

Individuals who require minimal support or assistance should not be directed to a 16 shelter that provides a greater level of support services than what they need. For 17 example, an elderly individual who functions without assistance in his or her 18 home may be confused and in need of assistance in the shelter environment. A 19 person with a cognitive or psychiatric disability may need direction with the 20 change in daily routine. These individuals may be accommodated with minimal 21 assistance in a general population shelter. Likewise, individuals with special 22 needs usually function best when kept with their family or caregiver. Keeping 23 these individuals united with their caregivers can help them function in a general 24 population shelter with minimal support from shelter staff. To avoid the 25 inappropriate placement of individuals, plans for general population shelters 26 should also take into account possible resources to supply durable medical 27 equipment or medication for those who require these basic resources. 28

Triage staff should acknowledge the need for family-centered care. Parents are 29 usually unwilling to be separated from their children for any reason, including 30 medical treatment. Additionally, staff members should be prepared for the needs 31 of children who are not accompanied by a caregiver. 32

SERVICE ANIMAL POLICY 33

The absence or presence of a service animal can mean the difference between a 34 person who requires regular assistance from shelter staff and a person who can 35 function independently. The ADA defines “service animal” as any “guide dog, 36 signal dog, or other animal individually trained to provide assistance to an 37 individual with a disability.” Service animal jobs include: 38


• Guiding individuals with impaired vision. 1

• Alerting individuals who are deaf or hard of hearing (to intruders or 2 sounds such as a baby’s cry, the doorbell, and fire alarms). 3

• Pulling a wheelchair. 4

• Fetching dropped items. 5

• Alerting people to impending seizures. 6

• Assisting people with mobility disabilities with balance or stability. 7

Service animals are not household pets or companion animals (household pets 8 are typically not allowed into shelters) but it can be difficult for first responders 9 and shelter staff to delineate between the two because service animals do not 10 have to be licensed or certified by the government. Likewise, the Americans with 11 Disabilities Act (ADA) does not require service animals to have specific training. 12 A service animal may be excluded from a place ONLY if its behavior is a direct 13 threat to the health or safety of people. 14

During a disaster, a service animal is expected to accompany its owner in 15 rescue/evacuation vehicles and shelters, clinics, and any other facility related to 16 the emergency (such as a Federal Recovery Center). FEMA will be issuing 17 additional guidance on the management of both household pets and service 18 animals. 19

E. EVACUATION 20

Local emergency managers, along with government authorities and service 21 providers, should consider the demographic composition of the community, the 22 transportation necessary for evacuation, and the capacity to provide shelters that 23 meet the range of needs that exist within the community. Evacuation planning 24 should take into account regulations, licensing, and other mandated 25 responsibilities as well as resources, hazard analyses, and evaluation of 26 emergency circumstances. Although an evacuation plan must include clear 27 steps for all evacuation procedures for the entire population, particular attention 28 should be paid to the following: 29

• Clear policies defining the roles and responsibilities of first responders. 30

• Written agreements for procuring services during an emergency. 31

• Transportation and equipment resources that must be identified, 32 coordinated, and incorporated at all levels of government planning. 33


• A system for evacuating pre-identified individuals who require 1 assistance (with a particular emphasis on accessible transportation). 2

• Pre-identified, accessible sheltering sites. 3

• Recognition of the need to keep people with disabilities of any age with 4 their families and/or caregivers. 5

• Recognition of the need to keep people with disabilities and their 6 mobility devices, other durable medical products, and/or service 7 animals together. 8

• Establishment of a mechanism to track equipment when life safety 9 requires separation from the owner during evacuation. 10

• Recognition of the need to keep children and their parents or 11 guardians together. 12

• Recognition that at any point in time unaccompanied minors within the 13 community may be unable to understand the scope of the emergency, 14 access information, or know where to go for help. 15

• Consideration regarding the provision of services to undocumented 16 immigrants, by providing basic life safety intervention such as shelter 17 and food. 18

Based on the nature of the incident and resources available, Local governments 19 should make every possible effort to provide evacuation services to individuals 20 who need it. State, Territorial, Tribal, and Local governments should also make 21 full use of Federal funding assistance, from DHS and other agencies, which can 22 be directed at strengthening evacuation planning for special needs populations. 23

Because resources during an emergency will be in great demand, individuals 24 requesting assistance, particularly at the onset of an emergency, should 25 understand resources will likely be limited. Therefore, personal preparedness is 26 essential, and individuals with special needs and their caregivers should make 27 personal evacuation plans. They should also identify themselves to the Local 28 emergency management agency if they will require evacuation assistance and/or 29 special equipment, including transportation to evacuation staging areas. 30

EVACUATION FROM HAZARDOUS AREAS TO SAFE AREAS WITHIN A 31 JURISDICTION 32

Evacuations within a jurisdiction typically take place in the advent of incidents 33 with little or no warning (e.g., wildfires, floods, tornados, industrial accidents, 34 terrorist attacks) and affect only a portion of the population. Emergency 35


managers may be able to facilitate a successful evacuation by calling on 1 accessible transportation resources currently operating within the area such as 2 fixed route buses, paratransit vehicles, or school buses. Additional transportation 3 can also be provided by private entities (e.g., taxis, coach buses), non-profit 4 entities (e.g., hospitals, advocacy organizations, social services), and/or schools. 5 A system should be established connecting shelter staff, vehicle drivers, and 6 emergency managers to ensure individuals are evacuated to appropriate pre-7 identified shelters or facilities, including those with physical access, medical care, 8 and language assistance within the jurisdiction. 9

In addition to transportation plans for special needs populations (which will be 10 discussed at greater length in the next section), metropolitan areas should have 11 clear policies for evacuating older persons and individuals with disabilities from 12 high-rise buildings. For example, the city of Chicago implemented standards in 13 2002 requiring all commercial and residential structures more than 80 feet high to 14 have evacuation plans for people with disabilities. 15

EVACUATION FROM ONE JURISDICTION TO ANOTHER JURISDICTION 16

Evacuation from one jurisdiction to another usually takes place in advance of an 17 emergency with a certain degree of predictability, such as a hurricane. In 18 planning for such catastrophic incidents, States, Territories and Tribes should 19 facilitate collaboration across jurisdictions to ensure that capabilities for 20 supporting special needs populations are defined (e.g. transportation and 21 receiving shelters). 22 23 The demands of multiple-trip and long-distance travel will be especially 24 challenging for some individuals—both physically and mentally. Emergency 25 managers should designate and advertise staging areas for long-distance 26 transportation and provide additional transportation in the form of over-the-road 27 buses, school buses, or intercity rail to shelter locations outside the jurisdiction. 28 In general, over-the-road motor coaches rather than school buses, city buses, or 29 paratransit vehicles are preferred for evacuating people between metropolitan 30 areas. In many cases, there will be individuals living in the community who will 31 not be able to get to designated staging areas on their own. Given available 32 resources, plans should include mechanisms to assist these individuals. Once 33 individuals are transported from their initial location to a pick-up point, adequate 34 accessible vehicles should be available to transport them to the designated 35 shelter location. 36 37 Emergency managers should ensure individuals are not separated from their 38 mobility aids, medication, equipment, service animals, personal care providers, 39 or family members. Likewise, it is critical that children are not separated from 40 their caregivers and that plans are in place to care for unsupervised children. 41 Emergency planners should also anticipate that some individuals may require 42 supervision and assistance during a long-distance evacuation, especially if the 43


evacuation is prolonged by traffic congestion. Planners should ensure persons 1 traveling in a long-distance evacuation have the opportunity to receive food, 2 water, and non-emergency medical care such as assistance with taking 3 prescription medication. 4

Sustaining individuals awaiting evacuation is also critical. No jurisdiction has the 5 capability to simultaneously evacuate its entire population. Therefore, if a 6 phased evacuation is implemented and some individuals must wait for 12 or 7 more hours, the jurisdiction should determine how they will be sustained during 8 that period. Besides food and water, this may include assistance in obtaining 9 medicines, durable medical equipment, electricity, oxygen, or other resources 10 and shelter from the weather. 11

EVACUATION VERSUS SHELTERING IN PLACE 12

The decision to evacuate a congregate setting and individuals with special needs 13 residing in private residences requires careful planning and assessment of the 14 risk. In most States, residential facilities are required to have plans in place for 15 emergencies. Medical and nursing home facilities choose to shelter in place—16 finding it the safest and most comfortable option for their residents. To make 17 sheltering in place more feasible, many congregate settings have been 18 hardening their facilities by installing approved shutters, generators, etc. 19 Although the facilities are ultimately responsible for their residents, the 20 jurisdiction’s EOP should pre-identify these facility locations and have an 21 estimate of the number of individuals residing in each. It is also recommended 22 that emergency managers work with these facilities whenever possible to help 23 ensure their plans adequately and realistically address hazards and emergencies 24 common to that location. 25

When advance warning permits and when sheltering in place poses a greater 26 risk to the individual than evacuation, individuals who require acute medical care 27 should be evacuated 24 hours before the general population. Facilities in 28 neighboring jurisdictions should be ready to receive those displaced individuals 29 (agreements should be in place before the incident), and proper resources, 30 including medical supplies and appropriate staff, should be in place at the 31 receiving facilities. 32

WORKPLACES AND PUBLIC VENUES 33

For emergencies that cannot be anticipated, members of the community will be 34 going about their daily life activities when the incident occurs. Although business 35 and public venue managers have the responsibility of developing plans to be 36 prepared for an emergency, the Local emergency manager will be involved as 37 part of the response to an actual crisis. In addition, emergency management 38 professionals can strengthen community preparedness through advanced 39


planning with Local employers. As part of the emergency planner’s 1 preparedness message to employers, emphasis should be placed on: 2 3

• The necessity for commitment to emergency preparedness from 4 senior-level management within an organization; 5

• The importance of timely and accurate emergency communications 6 that are accessible to all employees and visitors, including individuals 7 with special needs; 8

• A two prong planning process that combines clear guidelines for all 9 occupants of the premises, while being customizable to meet the 10 unique circumstances of employees and visitors with special needs. 11

• Rigorous and regular practice of the employer’s emergency plan, 12 providing opportunities to evaluate procedures and keeping the issue 13 in the minds of agency managers and employees. 14

EVACUATION OF SCHOOLS 15

Like the evacuation of residential facilities, the evacuation of schools should be 16 thoroughly planned prior to an emergency. Most school districts have district-17 wide emergency management plans that are developed in collaboration with 18 community partners (e.g., fire, police, and emergency medical services). Each 19 school within a district is responsible for developing a school-based emergency 20 management plan that is based on the unique architectural, geographical, and 21 student population characteristics of the school. This plan is developed by 22 establishing a school-based emergency management team that may include 23 community partners and school-based personnel such as facilities managers, 24 cafeteria managers, nurses, disability specialists, counselors, teachers and 25 administrators. 26 27 The school-based emergency plan should include procedures and processes for 28 ensuring the full-participation of students and staff with disabilities in the event of 29 an evacuation, lockdown, or shelter-in-place. Each school-based emergency 30 management plan should identify how to best address a variety of disabilities— 31 including visual, hearing, mobility, cognitive, attention and emotional—to 32 adequately consider their needs and vulnerabilities. 33

Communities should have plans in place to manage traffic around a school as 34 panicked parents attempt to reach their children. Urban school children often 35 arrive on foot, by car, or on public transportation, none of which may be viable 36 options during an emergency. Suburban or rural schools may not be located 37 within a reasonable distance of a suitable evacuation site. Additionally, plans 38 must ensure the transportation being used is appropriate for the transportation of 39 students with disabilities. For example, school buses will not work for individuals 40


using wheelchairs if the buses do not have lifts. The drivers of these vehicles 1 must also know how to operate wheelchair lifts, use tie downs, and transfer 2 individuals who have disabilities or who are frail. Should an entire community 3 require a simultaneous evacuation, most school districts do not have enough 4 buses to provide concurrent service. Likewise, some private and non-public 5 schools may rely on public school busses for transportation during normal 6 operations 7

The emergency management plan should also identify an evacuation site that is 8 accessible to students and staff with disabilities. For example, an evacuation 9 route that involves climbing over a hill may be difficult for those using wheelchairs 10 and other mobility devices. The evacuation site should have procedures for 11 receiving students with disabilities. Working with law enforcement, mental health 12 agencies, Red Cross, Salvation Army, and area businesses will help to provide 13 supplies and support for the reunification sites. For example, the police can help 14 control traffic and maintain order. Other partners can help feed hungry students, 15 care for students with medical needs, calm parents’ anxiety, and counsel 16 traumatized parents. 17

The plan should also outline procedures for reunifying the students with their 18 parents at a pre-identified reception site. The parent/child reunification process is 19 often a highly emotional and chaotic event, and having staff with the appropriate 20 skill sets to manage such situations is critical. 21

Likewise, the use of the National Emergency Family Registry and Locator 22 System (NEFRLS) can be of great benefit. The NEFRLS toll-free number allows 23 disaster victims without access to the Internet to register or search the system on 24 their own or with the help of NEFRLS call center staff. In the absence of a 25 presidentially-declared disaster, the NEFRLS posts a recorded message that 26 refers callers to appropriate local authorities, the American Red Cross, the 27 National Center for Missing and Exploited Children or the National Emergency 28 Child Locator Center for further assistance. 29

F. TRANSPORTATION 30

Transportation is the core component of evacuation. Identification of available 31 transportation resources and coordination of those limited resources is 32 paramount to the evacuation’s success. The Nationwide Plan Review Phase 2 33 Report indicated that, “a critical but often overlooked component of the 34 evacuation process is the availability of timely accessible transportation—35 especially lift-equipped vehicles.” Establishing solid agreements with vendors, 36 and detailing specialized services and equipment needed before an event is 37 critical. 38


INDIVIDUALS NEEDING TRANSPORTATION ASSISTANCE 1

Populations that will require transportation assistance during emergency 2 response and recovery include: (1) individuals who do not have access to a 3 vehicle but can independently arrive at a pick-up point; (2) individuals who do not 4 have access to a private vehicle and will need a ride from their home; (3) 5 individuals who live in a group setting or assisted living environment and will 6 need a ride from such facilities; (4) individuals who are in an in-patient medical 7 facility or nursing home; and (5) individuals who are transient, such as people 8 who are homeless, and have no fixed address. 9

Evacuation plans should outline procedures to ensure the availability of sufficient 10 and timely accessible transportation to evacuate facilities or neighborhoods with 11 a high concentration of residents who need additional assistance. These 12 locations include nursing homes, group homes, assisted living facilities, clusters 13 of home-based care clients, retirement communities, and other locations where 14 individuals with disabilities are dependent on accessible transportation. When 15 possible, emergency managers should arrange for staff and volunteers to be 16 placed at staging areas and within transportation vehicles to offer assistance. To 17 match available resources to projected needs for various types of transportation, 18 emergency managers should use their special needs population assessments 19 and registries (if a registry has been created), as well as GIS mapping options. 20

IDENTIFICATION OF TRANSPORTATION RESOURCES 21

Emergency managers should be aware that approximately 64 Federal programs 22 support transportation services for special needs populations on a daily basis. Of 23 these programs, approximately 34 operate vehicles or contract for services. 24 Examples of these programs include Local area agencies on the aging, mental 25 health day habilitation programs, and vocational rehabilitation programs. It is 26 important for emergency planners to collaborate with these routine transportation 27 providers to identify individuals who might require transportation assistance 28 during an evacuation. This will help determine appropriate forms of 29 transportation and enhance coordination among multiple service providers. 30

Many communities have public transportation resources, such as fixed route and 31 paratransit services, as required by the ADA. Human service agencies such as 32 aging networks and Medicaid also own vehicles through a variety of federally 33 funded programs. Emergency managers should determine whether the area’s 34 existing fleet of low-floor and accessible buses, school buses, over-the-road 35 buses, or light rail, heavy rail, or intercity rail vehicles could be used to evacuate 36 people without access to personal vehicles. Private schools, taxi services, non-37 profit, and other private charter bus companies are also important partners for 38 identification of vehicles with and without lift equipment. Buses equipped with 39 two-way radios capable of communication with a dispatcher and/or Emergency 40 Management Agency greatly aids evacuation coordination. Although these 41


resources will be critical during an emergency, the extent to which they will be 1 able to provide transportation assistance will depend on: 2

• The nature and type of the incident, such as whether the incident is a 3 no-notice or advance-notice event. 4

• The time of day and day of the week the incident takes place. 5

• Whether the transportation network sustained damage in an incident. 6

• The location of the incident relative to the location of transit vehicles 7 and routes. 8

• Whether people need to be evacuated over long distances. 9

EMERGENCY TRANSPORTATION CONSIDERATIONS 10

The following considerations are critical to avoid potential pitfalls in emergency 11 transportation planning: 12

• Transportation providers may have pre-arranged agreements with 13 multiple facilities—essentially “double-” or “triple-booking” them—14 risking insufficient services should an emergency affect an entire State 15 or region. 16

• Many contracts between transportation providers and facilities have a 17 provision that allows the transportation company to opt out at the last 18 minute. Although this is standard contract language because buses 19 may be on a trip and unavailable, it leaves the facility without 20 transportation. 21

• Many jurisdictions have contracts in place for buses and must 22 predesignate drivers. Transportation plans should include the workers, 23 which often involve union rules, and the requests made to these 24 workers should be detailed. For example, does the plan allow for the 25 bus driver to take his or her family on the bus? 26

• Identifying where individuals are located, particularly during the day, 27 can be problematic especially when people are served by multiple 28 transit providers. 29

• In some jurisdictions, there are laws limiting where buses may go and 30 neighboring counties may be off limits. If this is the case, it is 31 recommended that laws be adjusted to allow for exceptions during 32 emergencies. 33


• If an evacuation takes place during a school day, school bus drivers 1 may not be available to assist with the evacuation because they will be 2 driving children to or from home. Additionally, these drivers are 3 typically not trained or contracted for emergencies and may not be 4 available to provide assistance to some special needs individuals. 5 Establish alternative agreements to account for this possibility. 6

• Establish shelter policies to ensure transportation providers have 7 specific information on evacuation routes and shelter locations. 8

• Develop procedures for reimbursing transportation providers for 9 expenses they incur during an evacuation, to ensure their assistance in 10 the future. 11

• Transportation providers will be less likely to assist if they are 12 concerned about liability issues. Where possible, State, Territorial, 13 Tribal, and Local jurisdictions should work to establish agreements that 14 reduce the liability of transportation providers in case of an accident or 15 injury. 16

• In addition to transportation resources, consideration should be given 17 to the availability of support equipment such as portable oxygen, 18 special needs cots, accessible portable toilets, drinking straws, and 19 communication devices for the evacuation process. 20

• Make provisions for transporting persons with disabilities and their 21 service animals as a unit without separating the persons/animals from 22 each other or segregating them from the general population. 23

LEGAL CONSIDERATIONS 24

State, Territorial, Tribal, and Local jurisdictions must take into consideration a 25 variety of legal and regulatory requirements when coordinating emergency 26 transportation. As discussed earlier, planners should make use of available 27 guidance from the Department of Health and Human Services Office for Civil 28 Rights about how the HIPAA Privacy Rule permits covered entities to disclose 29 identifiable health information for planning purposes 30

Some public- and private-sector transportation providers are reluctant to provide 31 service without memorandums of agreement with the State, Territorial, Tribal, or 32 Local jurisdiction regarding liability and reimbursement. Such agreements 33 typically require time, money, and legal representation—resources governments 34 may not have readily available. Additionally, private transportation providers 35 often will not provide transportation without formal sheltering arrangements being 36 in place to eliminate unexpected complications. As this point illustrates, the 37 transportation, evacuation and sheltering of special needs individuals does not 38


exist in a vacuum—each component of an emergency plan affects and is 1 inextricably linked to the other components. 2

G. HUMAN SERVICES AND MEDICAL MANAGEMENT 3

HUMAN SERVICES 4

Human services promote the economic and social well-being of families, 5 children, individuals, and communities by providing the public with such services 6 as welfare, food stamps, social services, child support, economic assistance, 7 rehabilitation, and other supports for individuals with disabilities, or other special 8 needs. These services are provided through Federal, State, Territorial, Tribal, or 9 Local governments, and non-governmental entities, including private and/or 10 nonprofit organizations, and faith-based and community organizations. They 11 serve as a safety net for people and communities with limited personal and/or 12 economic resources and provide immediate, short term, assistance in meeting 13 basic needs. Individuals with special needs may rely on human services to 14 maintain their independence, supplement their economic resources, and receive 15 medical care (particularly for chronic conditions). 16

A regional incident may adversely impact the availability of the human services 17 routinely used by individuals with special needs. A number of critical activities 18 and programs delivering human services could be adversely affected by damage 19 to, or excessive demand placed on, key components of the human services 20 resource infrastructure. Potentially affected activities in human services include 21 transportation, child care, child support, developmental disabilities services, 22 foster care, refugee programs, homeless shelters, social services programs, and 23 aging services. Medicare/Medicaid benefits may not be immediately available if 24 affected areas are evacuated, mail service is interrupted, or persons who live in 25 the community are relocated to an institutional setting. 26

A regional incident could also create significant new demands for human 27 services, thus necessitating the need for increased flexibility in the provision of 28 these services. Individuals who did not routinely use human services, including 29 individuals whose health conditions are exacerbated by the incident or who 30 develop a disability as a result of the event, may find themselves in need of these 31 services. Individuals with limited English proficiency may become more isolated 32 if the incident leaves them without their familiar social and cultural network. 33 Persons with chronic medical conditions who live in their own homes, including 34 children, may find themselves in life-threatening situations as the availability of 35 in-home healthcare becomes limited as a result of the incident. 36

Many people will need assistance, including the provision of individual case 37 management support, with reestablishing and applying for human services 38 programs and benefits. They may not be aware of the full array of services 39 available to disaster victims and they may need assistance in completing forms, 40


understanding eligibility requirements, and arranging for continuity of services. 1 Local collaboration between planners and providers will be necessary to quickly 2 and effectively reestablish human services support for persons with special 3 needs. In addition, important information relating to the agency and recipient civil 4 rights obligations, assistance options, and resources for those experiencing 5 difficulty in accessing services, should be provided in multiple languages. 6

Planning for the reestablishment of the human services infrastructure and 7 alternate arrangements is best achieved during the initial stages of emergency 8 planning with input from a Local human services network. Keep in mind that 9 Local human service providers will need support in developing emergency plans 10 for themselves as well as their constituents. 11

During a presidential disaster declaration, FEMA, as coordinator for ESF 6 – 12 Mass Care, Emergency Assistance, Housing and Human Services, is 13 responsible for ensuring the needs of disaster-impacted populations are 14 addressed by coordinating Federal assistance. FEMA will implement programs 15 to assist with the replacement of destroyed personal property, and obtain 16 disaster loans, food stamps, crisis counseling, disaster unemployment, case 17 management, and other Federal and State benefits. FEMA will also support the 18 specialized sheltering, as discussed in Part D of Section V. 19

MEDICAL RESOURCES 20

Emergency plans should identify personnel and pharmaceuticals available in the 21 jurisdiction to support a surge in the number of individuals needing ongoing 22 medical support. Medical resources available within the NGO and private sector 23 should not be overlooked. Trained professionals who have experience working 24 with special needs populations should be identified as part of the planning 25 process to offer health services, including mental health services and services for 26 children. 27

POTENTIAL SHORTAGE OF STAFF 28

Perhaps the most difficult resource to acquire during a disaster is additional 29 staffing. When establishing pre-agreements between shelters and/or medical 30 facilities and health care professionals, it is important to ensure multiple facilities 31 are not all depending on the same personnel. Each hospital or congregate 32 setting should have carefully detailed contingency plans for calling in off-duty 33 personnel (especially at night) to provide surge capacity at their institutions. 34 Some hospitals have developed memorandums of understanding with institutions 35 outside the region to provide care to transferred patients, or to provide supplies 36 and personnel. Emergency managers should encourage private medical sector 37 personnel to make these connections with other healthcare institutions. 38


Additionally, State, Territorial, or Tribal governments that are party to the 1 Emergency Management Assistance Compact (EMAC) should be aware that 2 their jurisdiction will recognize the out-of-state licenses and professional 3 certifications of professionals sent to assist in emergency response and recovery 4 efforts pursuant to EMAC. EMAC is a congressionally ratified compact that 5 provides for member jurisdictions to exchange assistance in the form of 6 equipment, resources, and personnel during a governor-declared emergency. In 7 order for EMAC to be activated, the designated official of the aid-requesting State 8 or Territory must request the type of assistance he or she needs from the aid-9 rendering State(s). Currently, all fifty states, Puerto Rico, the District of 10 Columbia, and the U.S. Virgin Islands are parties to EMAC. 11

Local planners should also look for, and promote the formation of, medical surge 12 programs such as the Medical Reserve Corps. MRC is a program with more 13 than 680 Local units and 121,000 volunteers whose mission is to establish teams 14 of Local volunteer medical and public health professionals to contribute their 15 skills and expertise throughout the year, as well as during times of community 16 need. Local planners should encourage practitioners with experience with 17 special needs populations, such as pediatricians, to join these MRCs. 18

CREDENTIALING 19

Systems should be in place to identify and validate the credentials of health 20 service staff, particularly medical personnel, who volunteer their services during 21 an emergency. Ideally, Federal, State, Territorial, and Tribal systems should be 22 similar to incorporate medical volunteers, regardless of their affiliation, into 23 emergency operations. 24

In 2002, Congress authorized the development of the Emergency System for 25 Advanced Registration for Volunteer Health Professionals (ESAR-VHP). The 26 goal of ESAR-VHP is to assist grant awardees of the Federal National 27 Bioterrorism Hospital Preparedness Program Cooperative Agreements in 28 establishing a pre-registration system for emergency volunteer health 29 professionals. This system is State-based and will, when complete, form a 30 national system that will organize the use of health professional volunteers in 31 emergencies. The system will provide verifiable, up-to-date information 32 regarding the volunteer’s identity and credentials to hospitals or other medical 33 facilities in need of the volunteer’s services. Each State’s ESAR-VHP system is 34 intended to be built to standards that will allow quick and easy exchange of 35 health professionals with other States, thereby maximizing the size of the 36 population able to receive services during a time of a declared emergency. 37

PHARMACEUTICALS AND DURABLE MEDICAL SUPPLIES 38

Public and private insurance programs limit the amount of prescription drugs 39 people can order at one time. This restriction therefore limits individuals who may 40


need to fill prescriptions immediately following an emergency. Once a 1 jurisdiction’s population assessment is complete, emergency planners should 2 identify resources for medical supplies necessary to support individuals during an 3 emergency. This determination should include pharmaceuticals used by children 4 as well as pediatric-sized and extra large equipment. State, Territorial, Tribal, 5 and Local governments should develop pre-agreements for pharmaceuticals and 6 durable medical equipment, keeping in mind they might need supplies not 7 typically found in emergency facilities or on ambulances. 8

PATIENT TRACKING 9

During an emergency, many individuals are separated from family members and 10 loved ones because they are confused, noncommunicative, or otherwise unable 11 to provide information about themselves. Many individuals also become 12 separated from the hospitals or facilities where they receive care. For these 13 reasons, tracking individuals is crucial and should be written into the standard 14 operating procedures for all relevant entities (health departments, medical care 15 facilities, EMS, etc). 16

As a result of the stress associated with an emergency incident, some people 17 may have difficulty identifying themselves and/or providing basic information to 18 authorities. People with pre-existing mental health conditions may be particularly 19 vulnerable to stress-induced behavioral changes, and symptoms could become 20 exacerbated as a result of the incident. Some jurisdictions have implemented an 21 electronic tracking system using bracelets. Electronic bracelets are useful 22 because they reduce the risk of identity theft and can hold a great deal of 23 information. Bracelets do not have to be electronic, however, and may simply 24 display the person's name, date of birth, and, for people dependent on the care 25 of others, the residence or facility where they were located. Consideration of 26 where to place the bracelet should be based on the behavior being exhibited by 27 the person. For example, a person who is extremely agitated may wear the 28 bracelet around the ankle to deter removal. It may also be useful to call this 29 bracelet “your ticket home” to remind people of its purpose. For people 30 dependent on the care of others, inclusion of photographic identification can be 31 helpful. Likewise, durable medical equipment, wheelchairs in particular, should 32 be labeled for owner identification. Identification mechanism should be durable 33 and created as quickly and easily as possible. 34

H. CONGREGATE SETTINGS 35

PLANNING 36

Emergency managers should be familiar with the emergency plans and 37 regulations of congregate settings (e.g., nursing homes, adult homes, group 38 homes, children’s homes, daytime activity centers, rehabilitations centers) within 39 their jurisdiction. Although there are no uniform plans in place for congregate 40


settings, they are typically responsible for their own evacuation and sheltering. A 1 State, Territorial, or Tribal planning template and open forum about what 2 assistance the government can provide will help facilities with the planning 3 process. Likewise, in the event power is lost and must be restored in stages, it is 4 recommended that State, Territorial, Tribal, and Local jurisdictions prioritize 5 congregate settings where individuals are dependent on life-sustaining 6 equipment. 7

RESIDENTIAL HEALTHCARE FACILITIES 8

Residential Healthcare Facilities (RHCF), such as hospitals, should have 9 comprehensive shelter-in-place, evacuation, and continuity of operations plans in 10 place. When sheltering-in-place, RHCFs are responsible for the provision of 11 services to their clients and staff. When not sheltering-in-place, the RHCF 12 should have plans established for “like-to-like” evacuations, where one residential 13 care facility evacuates to one or more facilities that provide the same type and 14 level of specialized care. Doing so helps prevent the hospital system from 15 becoming overburdened and promotes a safe transfer of medically fragile 16 persons. The reality, however, is that a transfer of an entire facility is complex, 17 labor and resource intensive, and the process rarely results in a 1:1 facility ratio. 18 Further, these plans should take into account the transfer of the client base, the 19 care staff (and their families too if necessary), as well as medical/case records, 20 equipment and supplies, linens, and food. RHCFs are responsible for all aspects 21 of their evacuations, but it is highly likely they will request government 22 assistance—a consideration emergency managers should factor into emergency 23 planning. 24

Although RHCFs are supposed to have emergency evacuation plans and facility 25 agreements in place, there have been instances where RHCFs have transferred 26 their clients to general population shelters. The State of Florida has legislation 27 that makes it illegal for RHCFs to leave individuals who are in their care at 28 nonmedical shelters or hospital emergency rooms. 29

Whether planning for sheltering in place, moving clients from one similar facility 30 to another, or being prepared to take care and manage individuals from facilities 31 that failed to adequately plan for emergencies, the planning process should be 32 comparable to the development of the special needs and shelter planning. 33 RHCFs, Local emergency management and health departments, and community 34 and faith-based organizations should all work together to ensure RHCF plans are 35 realistic and appropriate. 36

MEDICAL RECORDS 37

It is critical that Local planners encourage the public and private medical sectors 38 (primary care physicians and specialty clinics at tertiary care centers) to develop 39 mechanisms for redundant medical records. Records should be available in 40


paper form and if possible, electronically. Local planners should also advocate 1 for statewide immunization registries that would remain intact even if paper 2 records are destroyed. Further, Local planners should promote as part of its 3 personal preparedness campaign medical record storage on CDs, USB drives, 4 and through private medical information services. During a disaster paper 5 medical records may be lost; electronic medical records will safeguard against 6 this loss and could prove invaluable. 7

I. RECOVERY 8

The recovery phase of a disaster is never easy, and the difficulties can be 9 compounded for individuals with special needs. In addition to personal losses 10 and injuries, individuals with special needs might lose vital connections with 11 personal care providers, service animals, community liaisons, public 12 transportation, neighbors, and other people integral to their everyday support 13 network. These disconnections create disruptions in services that people with 14 special needs rely on to participate in daily life. 15

Jurisdictions most successful at recovering from disasters have established 16 formal relationships with a variety of community organizations that provide a link 17 to the special needs populations they serve. By working together on an ongoing 18 basis to develop a joint plan of recovery, government agencies and community 19 organizations will be better able to identify not only assets and capabilities, but 20 also opportunities for improvement and cooperation. The players in this process 21 should consider developing mutual aid agreements and memoranda of 22 understanding (MOUs) that cover procedures for sharing resources. Proactively 23 forming partnerships with community organizations can lead directly to improved 24 community recovery for all affected segments of special needs populations. 25 26 In the early stages of recovery, a coherent system for the reunification of support 27 networks and to reunite children with their parents or guardians or elderly 28 persons with their caregivers is essential. The system should take into account 29 adults and children who are wounded, nonverbal, or have limited English 30 proficiency, as well as potential legal issues regarding custody (in the case of 31 children). To assist with reunification of families and other caregivers, State, 32 Territorial, Tribal, and Local jurisdictions may also wish to establish a system to 33 collect, organize, and report information about the status and location of 34 displaced persons. The requirements of this database are similar to those of a 35 registry in that State, Territorial, Tribal, and Local governments must determine 36 who will establish, update, and fund the database. The American Red Cross 37 recently launched the Safe and Well Web Site to provide families with a tool to 38 exchange welfare information with loved ones and friends in the immediate 39 aftermath of a disaster. The Safe and Well Web Site, accessible via 40 www.redcross.org, allows disaster victims to select and post standard messages 41 for friends and family that indicate they are safe and well at a shelter, home, or 42 hotel and will make contact when they are able. In addition, FEMA has 43 developed the National Emergency Family Registration and Locator System 44


(NEFRLS) as required by the Post-Katrina Emergency Management Reform Act 1 of 2006 to assist families with locating missing loved ones during a declared 2 disaster. More information on NEFRLS is available in Part E of Section V. 3

Developing a priority facility restoration list will expedite the recovery process. 4 Hospitals should be the number one priority for restoration of services, as should 5 dialysis facilities to keep hospital intake levels as low as possible. The next 6 facility priority may be schools and day care centers because they are necessary 7 to help get people back to work and stimulate the economy. 8

Adequate support mechanisms should be planned to meet mental and behavioral 9 health needs in the weeks and months following a disaster. Previous disasters 10 have demonstrated that these stressful situations often lead to dramatic 11 increases in suicide, domestic violence, and child abuse, as well as 12 exacerbations of pre-existing physical and mental health issues. Mental health 13 resources should be available and organizations serving individuals with special 14 needs should be made aware of the availability of such resources and the means 15 of accessing them. Ideally, assistance should be provided in familiar settings, 16 such as schools, service provider offices, and community healthcare provider 17 offices. 18

Each jurisdiction should provide translation and interpreter services to support 19 the disaster assistance application process, medical care, and other services 20 needed as a result of the disaster. Volunteer assistance provided by individuals 21 with special needs can also help disaster victims receive the level of support they 22 require during recovery operations. This support of individual resiliency is a vital 23 part of any successful recovery plan. 24

Long-term sheltering, in particular, can be a significant challenge for some 25 segments of the special needs population—particularly children, individuals with 26 disabilities, and individuals with healthcare needs. Accessibility of both 27 temporary and permanent housing is crucial. Timely allocation of adequate stock 28 of accessible housing safeguards against individuals with disabilities (e.g., 29 physical impairments) having to remain in a shelter environment longer than 30 others or being inappropriately relocated to a congregate setting.8 Congregate 31 settings should, whenever possible, have memorandums of agreement in place 32 with facilities in neighboring States or jurisdictions to house displaced residents. 33 In addition, emergency housing provided through Federal funding, and State and 34

8 The Supreme Court’s ruling on June 22, 1999 (Olmstead v. L.C.) upheld the ADA’s requirement that persons with disabilities should be integrated into their communities whenever possible. The ruling concluded that “unjustified isolation” (e.g. institutionalization when a doctor finds community treatment of equal benefit) to be discrimination. Several States (such as California, Delaware, New Hampshire, New Mexico, New York, Oklahoma, Vermont, and Virginia), have created task forces as a result of this legislation. For more information on State responses to this court decision, go to: http://www.ncsl.org/programs/health/forum/olmsreport.htm


Local housing subject to the Fair Housing Act, is required to meet physical 1 accessibility requirements. For more information about these requirements, see 2 Appendix F, as well as the FEMA Reference Guide at 3 http://www.fema.gov/oer/reference. 4

As Federal and/or State funding is received, the jurisdiction should recognize its 5 obligations to involve special needs populations in the planning for community 6 restoration (see Appendix F.) In instances where critical infrastructure is 7 destroyed, the recovery process presents an opportunity for urban planners to 8 ensure new buildings meet accessibility requirements, where perhaps the old 9 buildings did not. This should be considered as part of the long term mitigation of 10 future impacts on the community. 11

J. TRAINING AND EXERCISES 12

Emergency plans and procedures are only useful when accompanied by 13 comprehensive training and exercise programs. These programs are meant to 14 strengthen the overall effectiveness of plans by “testing” all or some components 15 of the plan, identifying strengths and weaknesses, and identifying solutions to 16 improve existing procedures and protocols. From past experience, it is clear that 17 if included, individuals with special needs can: 18

• Assist emergency managers in developing plans that take into 19 consideration special needs issues within their community. 20

• Identify weaknesses and gaps in plans that require further 21 development. 22

• Help develop solutions and resources within the community that can 23 support the emergency management system. 24

• Articulate emergency needs within their communities. 25

• Encourage overall greater collaboration, coordination, and 26 communication before, during, and after disasters. 27

• Provide opportunities to build awareness about special needs and 28 emergency preparedness issues. 29

Emergency management agencies and other response agencies should partner 30 with special needs populations to identify how to incorporate these issues in 31 existing training/exercise, and make it a matter of protocol to include them in 32 such programs. 33

There are creative ways to include people with special needs in training and 34 exercise programs. Some key considerations are as follows: 35


• Work with special needs communities to determine the best way to 1 involve them in the process. Work with the special needs advisory 2 committee, government agencies, and other voluntary organizations to 3 ensure effective and meaningful participation. 4

• Identify a representative sample of the population to be involved in the 5 onset to help develop goals and objectives for the programs. 6

• Be sure to involve special needs communities in all aspects: 7 development, testing/piloting, implementation, and evaluation. 8

TRAINING 9

People with special needs have been involved in all different aspects of 10 emergency management training as developers, trainers, and participants. In the 11 emergency management spectrum there are several types of training that should 12 be inclusive and incorporate special needs issues, these include: 13

• First responder training (fire, law enforcement, EMS)—this is ongoing 14 through a first responder’s career. 15

• Community-based training and education (e.g., community disaster 16 preparedness and outreach). 17

• Volunteer training (American Red Cross, The Salvation Army, CERT, 18 etc.) 19

• Emergency management agency training on specific hazard 20 annexes/plans (e.g., hurricane, evacuation, sheltering, pandemic flu, 21 HazMat, terrorism, etc.). 22

• Cross-training. It is important to provide training on emergency 23 preparedness issues (command structure, evacuation, sheltering, etc.) 24 for special needs populations, and equally important to train the 25 emergency preparedness community on special needs issues. This 26 will help foster a better understanding of each perspective. 27

The FEMA Emergency Management Institute (EMI) offers a free, online 28 Independent Study course (IS 197) and classroom instruction offered by States 29 (G 197), “Emergency Planning and Special Needs Populations.” Visit the EMI 30 Web site http://training.fema.gov/index.asp or contact EMI for more details. 31

EXERCISES 32

Exercises and drills are used to test the effectiveness of plans. The DHS 33 Homeland Security Exercise and Evaluation Program (HSEEP) identifies seven 34


types of exercises: seminars, workshops, tabletop exercises, games, drills, 1 functional exercises, and full-scale exercises. This variety provides options to 2 best suit the need. DHS-funded exercises are required to follow HSEEP, and 3 most Localities, States, and Tribes now adhere to it as well. Supporting HSEEP 4 are the Target Capabilities and the Exercise Evaluation Guides derived from 5 them. Those responsible for integrating special needs into exercises and 6 exercise programs should be conversant in this material. 7

When developing an exercise, take the following points into consideration: 8

• Be knowledgeable of the HSEEP and the Target Capabilities. 9

• It is important to include SMEs and/or representatives from special 10 needs populations as active participants in emergency exercises (as 11 planners, controllers, evaluators, and participants). 12

• It is vital that all facilities chosen for purposes of conducting an 13 exercise be accessible. This will ensure players, observers, staff, and 14 members of the public will be able to fully participate and receive any 15 necessary services. In addition, transportation, communication, 16 instructions should be provided in alternate formats to ensure access. 17

• Rather than have actors “play” the role of people with disabilities, 18 include people who have actual disabilities. Living with the disability 19 daily, these individuals have valuable perspectives and are more 20 readily able to identify issues and to provide ideas for effective 21 solutions. 22

• Include people with different types of special needs to enable the 23 collection of invaluable information about the effectiveness of plans. 24 This affords responders first-hand exposure to people with special 25 needs in disaster and emergency situations. 26

• Involve the special needs advisory committee, and include other 27 agencies and organizations that provide services to or advocate for 28 special needs populations. 29

• Carefully consider the inclusion of children in exercises. Children often 30 cannot distinguish between an exercise and actual event, which may 31 result in unintended emotional trauma. 32

After an exercise or drill, an after action report should be developed to capture 33 the exercise successes, needed improvements, and points of failure, and to 34 determine steps for corrective action. Work with the specific special needs 35 communities to review gaps or issues that were identified in exercises identifying 36 workable solutions.37


APPENDICES 1


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20



APPENDIX A – STATE, TERRITORIAL, TRIBAL, AND LOCAL 1

COMMUNITY PREPAREDNESS RESOURCES 2

• Accommodating Individuals with Disabilities in the Provision of Disaster Mass 3 Care, Housing, and Human Services Reference Guide. FEMA. 4 http://www.fema.gov/oer/reference/index.shtm 5

6 • ADA Best Practices Tool Kit for State and Local Governments. U.S. Department 7

of Justice. http://www.usdoj.gov/crt/ada//pcatoolkit/chap7shelterchk.htm 8 9

• An ADA Guide for Local Governments—Making Community Emergency 10 Preparedness and Response Programs Accessible to People with Disabilities. 11 U.S. Department of Justice. http://www.usdoj.gov/crt/ada/emergencyprep.htm 12

13 • At Risk Populations and Pandemic Influenza. Planning Guidance for State, 14

Territorial, Tribal, and Local Health Departments. Association of Territorial and 15 Health Officials (ASTHO). 16 http://www.astho.org/pubs/ASTHO_ARPP_Guidance_June3008.pdf 17

18 • Center for Disability and Special Needs Preparedness. 19

http://www.disabilitypreparedness.org 20 21

• Disability Preparedness Resource Center. U.S. Department of Homeland 22 Security. http://www.DisabilityPreparedness.gov 23

24 • Disabled People and Disaster Planning, DP2. http://www.citycent.com/dp2 25

26 • Emergency Assistance Guide. U.S. Department of Health and Human Services, 27

Administration on Aging. 28 http://www.aoa.gov/PRESS/preparedness/pdf/Attachment_1357.pdf 29

30 • Emergency Evacuation Planning Guide for People with Disabilities. National Fire 31

Protection Association. 32 http://www.nfpa.org/assets/files//PDF/Forms/EvacuationGuide.pdf 33

34 • Emergency Information Form. American Academy of Pediatrics. 35

http://www.aap.org/advocacy/epquesansw.htm 36 37 • Emergency Planning and Special Needs Populations. FEMA Emergency 38

Management Institute. http://training.fema.gov/index.asp 39 40 • Emergency Preparedness for Individuals with Disabilities, Part 1 & Part 2. IAEM 41

Bulletin March and April 2005. International Association of Emergency 42 Managers. http://www.iaem.com 43


1 • Emergency Transportation and Individuals with Disabilities. U.S. Department of 2

Transportation. http://www.disabilityprep.dot.gov 3 4

• Health Care Language Services Guide. 5 https://hclsig.thinkculturalhealth.org/user/home.rails 6

7 • I Speak Cards. http://www.ocjs.ohio.gov/Publications/Pocket%20Card.pdf 8

9 • LEP Resources. http://www.lep.gov/resources/resources.html 10

11 • Lessons Learned Information Sharing System (LLIS). Department of Homeland 12

Security. http://www.llis.gov 13 14

• National Association of Judicial Interpreters and Translators. 15 http://www.najit.org/DisasterRelief.html 16 17

• Nationwide Plan Review, Phase II Report. U.S. Department of Homeland 18 Security. https://www.dhs.gov/xlibrary/assets/Prep_NationwidePlanReview.pdf 19

20 • Preparedness Focus Areas: Pediatric Preparedness, Pediatric Disaster Tool Kit 21

New York City Department of Health and Mental Hygiene. 22 http://www.nyc.gov/html/doh/html/bhpp/bhpp-focus-ped-toolkit.shtml 23

24 • OK WARN: Weather Alert Remote Notification for the Deaf and Hard of Hearing. 25

NOAA National Severe Storms Laboratory. 26 http://www.nssl.noaa.gov/edu/safety/pagers.html 27

28 • The Paradigm Shift in Planning for Special-Needs Populations. 29

http://www.DisabilityPreparedness.gov 30 31

• Public Health Workbook to Define, Locate and Reach Special, Vulnerable, 32 and At-Risk Populations in an Emergency (Draft). U.S. Department of Health and 33 Human Services, Centers for Disease Control and Prevention. 34 http://www.bt.cdc.gov/workbook/#download 35

36 • Saving Lives: Including People with Disabilities in Emergency Planning. National 37

Council on Disability. 38 http://www.ncd.gov/newsroom/publications/2005/saving_lives.htm 39

40 • Special Population Planner. http://sourceforge.net/projects/spc-pop-planner 41

42 • Tips for First Responders. New Mexico Department of Health. 43

http://www.health.state.nm.us/ohem/first-responders.htm 44 45


• Why and How to Include People with Disabilities in Your Planning Process?. 1 Nobody Left Behind. 2 http://www.nobodyleftbehind2.org/findings/why_and_how_to_include_all.shtml 3

• Working Conference on Emergency Management and Individuals with 4 Disabilities and the Elderly. U.S. Department of Health and Human Services and 5 U.S. Department of Homeland Security. http://www.add-em-conf.com/index.htm 6

7


APPENDIX B – PERSONAL PREPAREDNESS RESOURCES 1

2 • Arizona Office for Americans with Disabilities Emergency Preparedness Check 3

List. http://www.azada.gov/EmergCkList/Cklist.asp 4 5 • Be Prepared - American Red Cross Preparedness Information. American Red 6

Cross. http://www.redcross.org/services/disaster/0,1082,0_500_,00.html 7 8 • Centers for Disease Control. http://www.cdc.gov/other/languages/ 9 10 • Disability Preparedness Resource Center. Department of Homeland Security, 11

Office for Civil Rights and Civil Liberties. http://www.DisabilityPreparedness.gov 12 13 • DisabilityInfo.gov. U.S. Department of Labor, Office of Disability Employment 14

Policy. www.disabilityinfo.gov 15 16

• El Condado de Orange lanza ListoOC Para Animar La Comunidad Latina a 17 Prepararse En Caso de Una Emergencia. Orange County, CA. 18 http://www.listooc.org 19

20 • Emergency Evacuation Planning Guide for People with Disabilities. NFPA. 21

http://www.nfpa.org/categoryList.asp?categoryID=824&cookie%5Ftest=1 22 23 • Emergency Information Form. American Academy of Pediatrics. 24

http://www.aap.org/advocacy/epquesansw.htm 25 26

• Emergency Management Be Prepared Kit: for Ohioans with Daily Functioning 27 Needs. Ohio Legal Rights Service. 28 http://olrs.ohio.gov/beprepared/beprepared.htm 29

30 • Emergency Power Planning for People Who Use Electricity and Battery 31

Dependent Assistive Technology and Medical Devices. 32 http://www.jik.com/disaster-individ.html#Guides 33

34 • Emergency Preparedness and People with Disabilities. U.S. Department of 35

Labor, Office of Disability Employment Policy. 36 http://www.dol.gov/odep/programs/emergency.htm 37

38 • Emergency Preparedness and Response. CDC. (English) 39

http://emergency.cdc.gov/; (Spanish) http://emergency.cdc.gov/spanish 40 41 • Emergency Preparedness Initiative, National Organization on Disability. 42

http://www.nod.org/index.cfm?fuseaction=Page.viewPage&pageId=11 43 44


• Emergency Preparedness: Taking Responsibility for Your Safety—Tips for 1 People with Activity Limitations and Disabilities. Los Angeles, County Office of 2 Emergency Management, Emergency Survival Program (2006). http://www.cert-3 la.com/education/EmergencyEvacuationPreparedness.pdf 4

5 • Evacuation Preparedness Guide. Center for Disability Issues in the Health 6

Professions. http://www.cdihp.org/evacuation/toc.html 7 8 • Family Readiness Kit. American Association of Pediatrics. 9

http://www.aap.org/family/frk/frkit.htm 10 11 • Guide to Disaster Preparedness for People with Disabilities. American Red 12

Cross/FEMA. http://www.redcross.org/images/pdfs/preparedness/A4497.pdf. 13 14 • Index of Printable Hurricane and Flood Materials (multiple languages). CDC. 15

http://www.bt.cdc.gov/disasters/hurricanes/printindex.asp 16 17 • Individual Emergency Preparedness for People with Disabilities, 18

Their Families and Support Networks. http://www.jik.com/disaster-19 individ.html#Guides 20

21 • Listo.gov. Department of Homeland Security. www.listo.gov 22

23 • Nobody Left Behind: Disaster Preparedness for People with Mobility Disabilities. 24

University of Kansas. http://www2.ku.edu/~rrtcpbs/resources 25 26 • OK WARN: Weather Alert Remote Notification for the deaf and hard of hearing. 27

NOAA National Severe Storms Laboratory. 28 http://www.nssl.noaa.gov/edu/safety/pagers.html 29

30 • Parent to Parent of New York State: Disaster Preparedness for Families of 31

Children with Special Needs 32 http://www.parenttoparentnys.org/Family2Family/F2FHICs_HelpingFamilies.pdf 33 34

• Preparedness Information for Seniors and People with Disabilities, American Red 35 Cross. http://www.redcross.org/services/disaster/0,1082,0_603_,00.html 36

37 • Protect Your Family and Property. Federal Emergency Management Agency. 38

http://www.fema.gov/plan/prepare/specialplans.shtm 39 40

• Ready New York for Seniors and People with Disabilities. New York City Office of 41 Emergency Management. 42 http://www.nyc.gov/html/oem/html/ready/seniors_guide.shtml 43

44 45


• Ready New York Household Preparedness Guide (multiple languages). New 1 York City Office of Emergency Management. 2 http://www.nyc.gov/html/oem/html/ready/household_guide.shtml 3

4 • Ready.gov. U.S. Department of Homeland Security. http://www.ready.gov 5

6 • Supporting Special Needs and Vulnerable Populations in Disaster. Prepare Now 7

Partners. http://www.PrepareNow.org 8 9

• Why and How to Include People with Disabilities in Your Planning Process? 10 Nobody Left Behind. 11 http://www.nobodyleftbehind2.org/findings/why_and_how_to_include_all.shtml 12


APPENDIX C – EXAMPLES OF NATIONAL ORGANIZATIONS 1

HAVING RESOURCES FOR SPECIAL NEEDS AND EMERGENCY 2

PREPAREDNESS 3

4 The following are examples of national organizations having Web-based resources 5 specific to special needs populations and emergency preparedness. This list is not 6 exhaustive, but provides initial resources in this topic area. This list will be further 7 developed with succeeding revisions to this planning guide. 8 9 10 AARP - http://www.aarp.org 11

American Academy of Pediatrics - http://www.aap.org 12

American Association on Health and Disability - http://www.aahd.us/page.php 13

American Council of the Blind - http://www.acb.org/ 14

American Hospital Association - http://www.aha.org/aha/about/ 15

American Public Health Association - http://www.apha.org 16

American Red Cross – www.redcross.org 17

Association of Maternal and Child Health Programs - http://www.amchp.org/ 18

Association of State and Territorial Health Officials - http://www.astho.org/ 19

Boat People SOS – http://www.bpsos.org 20

The Children’s Health Fund - http://www.childrenshealthfund.org/ 21

Emergency Nurses Association - http://www.ena.org/ 22

Independent Living Research Utilization (ILRU) - http://www.ilru.org/disaster-23 preparation.html 24

The Joint Commission - http://www.jointcommission.org/PublicPolicy/ep_home.htm 25

National Alliance on Mental Illness - http://www.nami.org/ 26

National Association of Children’s Hospitals - http://www.childrenshospitals.net 27

National Association of County and City Health Officials - http://www.naccho.org/ 28


National Association for the Deaf - http://www.nad.org/ 1

National Association of State EMS Officials - http://www.nasemsd.org/ 2

National Center for Disaster Preparedness, http://www.ncdp.mailman.columbia.edu/ 3

National Center on Immigrant Integration Policy - 4 http://www.migrationinformation.org/integration/language_portal/ 5

National Disability Rights Network – http://www.napas.org 6

National Organization for Victim Assistance - http://www.trynova.org/ 7

National Organization on Disability - http://www.nod.org/ 8

National Resource Center on Advancing Emergency Preparedness for Culturally 9 Diverse Communities - www.diversitypreparedness.org 10 11 National Spinal Cord Injury Association - http://www.spinalcord.org/ 12

Paralyzed Veterans of America - http://www.pva.org/ 13

Safety First, Easter Seals Disability Services - 14 http://www.easterseals.com/site/PageServer?pagename=ntl_safety_first 15

Save the Children USA - http://www.savethechildren.org/ 16

Telecommunications for the Deaf and Hard of Hearing (TDI) – https://www.tdi-online.org 17

The Arc of the United States - http://www.thearc.org/ 18

The Salvation Army - http://www1.salvationarmy.org 19

Think Cultural Health - http://thinkculturalhealth.org/ 20

United Cerebral Palsy Association - http://www.ucp.org/ 21

22 23 24


APPENDIX D – HIPAA PRIVACY RULE AND DISCLOSURES IN 1

EMERGENCY SITUATIONS 2

http://www.hhs.gov/ocr/hipaa/KATRINAnHIPAA.pdf 3 4 5

September 2, 2005 6 7 8 U.S. Department of Health and Human Services Office for Civil Rights 9 10

HURRICANE KATRINA BULLETIN: 11 HIPAA PRIVACY and DISCLOSURES IN EMERGENCY SITUATIONS 12

13 Persons who are displaced and in need of healthcare as a result of a severe disaster—14 such as Hurricane Katrina—need ready access to healthcare and the means of 15 contacting family and caregivers. We provide this bulletin to emphasize how the HIPAA 16 Privacy Rule allows patient information to be shared to assist in disaster relief efforts, 17 and to assist patients in receiving the care they need. 18 19 Providers and health plans covered by the HIPAA Privacy Rule can share patient 20 information in all the following ways: 21 22

TREATMENT. Healthcare providers can share patient information as 23 necessary to provide treatment. 24

o Treatment includes: 25 Sharing information with other providers (including hospitals and 26

clinics). 27 Referring patients for treatment (including linking patients with 28

available providers in areas where the patients have relocated). 29 Coordinating patient care with others (such as emergency relief 30

workers or others that can help in finding patients appropriate 31 health services). 32

o Providers can also share patient information to the extent necessary to 33 seek payment for these healthcare services. 34

35 36

NOTIFICATION. Healthcare providers can share patient information as 37 necessary to identify, locate and notify family members, guardians, or 38 anyone else responsible for the individual’s care of the individual’s 39 location, general condition, or death. 40

41 o The healthcare provider should get verbal permission from individuals, 42

when possible; but, if the individual is incapacitated or not available, 43


providers may share information for these purposes if, in their professional 1 judgment, doing so is in the patient’s best interest. 2

Thus, when necessary, the hospital may notify the police, the 3 press, or the public at large to the extent necessary to help locate, 4 identify, or otherwise notify family members and others as to the 5 location and general condition of their loved ones. 6

7 o In addition, when a healthcare provider is sharing information with disaster 8

relief organizations that, like the American Red Cross, are authorized by 9 law or by their charters to assist in disaster relief efforts, it is unnecessary 10 to obtain a patient’s permission to share the information if doing so would 11 interfere with the organization’s ability to respond to the emergency. 12

13 IMMINENT DANGER. Providers can share patient information with anyone as 14

necessary to prevent or lessen a serious and imminent threat to the health and 15 safety of a person or the public—consistent with applicable law and the 16 provider’s standards of ethical conduct. 17

18 FACILITY DIRECTORY. Healthcare facilities maintaining a directory of patients 19

can tell people who call or ask about individuals whether the individual is at the 20 facility, their location in the facility, and general condition. 21

22 Of course, the HIPAA Privacy Rule does not apply to disclosures if they are not made 23 by entities covered by the Privacy Rule. Thus, for instance, the HIPAA Privacy Rule 24 does not restrict the American Red Cross from sharing patient information. 25 26 For guidance on how personal health information may be shared for emergency 27 preparedness planning, visit http://www.hhs.gov/ocr/hipaa/decisiontool/tool/. The 28 decision tool addresses when and how a covered entity may disclose the number of 29 individuals it serves, as well as other data for planning purposes. 30 31


APPENDIX E – SPECIAL NEEDS REGISTRY INFORMATION 1

2 This appendix provides points for consideration related to establishing a special needs 3 registry. 4 5 6 If the State, Territorial, Tribal, or Local jurisdiction decides to create a registry, the first 7 step should be the identification of clear outcomes and objectives. It cannot be stressed 8 enough that expectation management is crucial—the person registering should have 9 appropriate feedback and a clear understanding of what assistance, if any, he or she 10 will receive during an emergency. 11 12 Potential registrants will likely be hesitant to give their personal information to the 13 government. It is imperative the confidentiality of the registrant be strictly 14 protected. DO NOT share the identities of the registrants of your program with anyone 15 but emergency response personnel on a need-to-know basis. Emphasize to registrants 16 that the process is completely voluntary, and the information provided to the 17 government will not be disseminated or used for anything other than emergency 18 assistance. Consult with legal counsel regarding the applicability of HIPAA and State, 19 Territorial, Tribal, and Local laws and regulations that govern the confidentiality of 20 information maintained in the registry. 21 22 In addition to addressing the registry objectives, State, Territorial, Tribal, and Local 23 jurisdictions should also answer the following questions before establishing a registry:9 24

• If the registry system is developed, will it be approved by the Local authorities? 25 • What will be the criteria for inclusion in the registry? 26 • Who will review applications for inclusion and make eligibility determinations? 27 • What allowances and accommodations will be made for people who are 28

temporarily disabled, including those in long-term rehabilitation, recovering from 29 a serious illness or hospitalized? 30

• What safeguards will be put in place to protect registrants’ privacy and the 31 confidential information they provide? When, how and with whom can this 32 information be shared? 33

• Who will maintain it? Who will fund it? 34 35 Registration can be accomplished by providing cards to be filled out and returned to the 36 emergency management agency by special needs individuals (or social services staff 37 representing special needs individuals). Annual distribution of the registration cards can 38 be sent by mail, listed in the newspaper, delivered with annual telephone books, or 39 distributed by social service organizations, churches, or medical facilities. An example 40 of a registry application, used by Monroe County, FL, can be found at 41

9 National Organization on Disability Emergency Preparedness Initiative; N.O.D.


http://monroecofl.virtualtownhall.net/Pages/MonroeCoFL_Social/Form1SNSregistryFilla1 ble.pdf. 2 3 In lieu of registration cards, individuals may register over the telephone with emergency 4 management officials or through the customer service number for a Local entity such as 5 a utility company. Some jurisdictions have used community service agencies or 6 community information hotlines to collect information, and others offer registration as an 7 option during hospital or congregate setting discharge or admittance. When one 8 member of an elderly household has entered a congregate setting, it may be prudent to 9 register the person still living in the home.10 10 11 There should be no fee charged for the service nor should there be a requirement for a 12 physician’s statement-of-need in order to participate. Individuals must simply be willing 13 to come forward and inform the emergency management agency that in the event of an 14 emergency they will need additional support or assistance. 15 16

10 Note: Registries are for individuals living in the community. Owners/managers of nursing homes and assisted living facilities are responsible for the evacuation and care of their residents.


APPENDIX F – CIVIL RIGHTS CONSIDERATIONS RELATED TO 1

SPECIAL NEEDS PLANNING 2

3 Introduction 4 5 Building upon the freedoms guaranteed by the Constitution, Congress and the 6 President have enacted several laws aimed at protecting the civil rights of populations 7 who historically have been subjected to discrimination. Federal civil rights legislation 8 prohibits discrimination based on characteristics, including the individual’s race, color, 9 national origin, religion, sex, age, and disability. Key civil rights legislation includes the 10 landmark Civil Rights Act of 1964, the Fair Housing Act of 1968, the Higher Education 11 Amendments of 1972, the Age Discrimination Act of 1975, the Rehabilitation Act of 12 1973, and the Americans with Disabilities Act of 1990. 13 14 Federal civil rights laws apply to emergency management agencies, as they operate 15 within the governmental and nongovernmental sectors. Discrimination during 16 Presidentially declared disasters is also specifically prohibited by Sections 308–309 of 17 the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988, as 18 amended. 19 20 It is important to note that proactive attention to civil rights considerations during all 21 phases of emergency management can lead directly to enhanced life safety and health 22 outcomes for impacted segments of the special needs population. The following are 23 some examples: 24 25 Mitigation and Preparedness 26 27

• Partnering with independent living, consumer service, and advocacy 28 organizations can extend the outreach to individuals with disabilities, helping 29 them to plan ahead for sheltering in place or evacuating from the home, school, 30 workplace, or community venue. 31

• Conveying public information in the primary languages of community members 32 can greatly increase the impact of preparedness messages. Likewise, conveying 33 information in pictures or with simple words can improve communication with 34 individuals who have little or no literacy abilities. 35

• Engaging leaders from distinct cultures can build community understanding, 36 trust, mitigate backlash discrimination, and improve the investigation following a 37 terrorist incident. 38

• Pre-selecting accessible mass care shelter sites can ensure individuals with 39 mobility limitations are not misdirected to medical shelters. 40

41


Response 1 2 • Issuing emergency alerts in visual and aural formats, as required by FCC 3

regulations, can convey critical and time sensitive information to community 4 members who are deaf and who are blind. 5

• Forging agreements with transit providers can ensure accessible vehicles will be 6 available for evacuation of individuals with physical disabilities and the elderly. 7

• Making advance arrangements with suppliers of pharmaceuticals and durable 8 medical equipment can enable individuals who require this support to function 9 independently in the immediate aftermath of a disaster. 10

• Training emergency responders to be vigilant in protecting children separated 11 from their parents or guardians can reduce the chance that a child would become 12 victim of a predator or that any medical condition would go unnoticed. 13

14 Recovery 15

16 • Coordinating in advance with community organizations can help to ensure case 17

management, mental health services, and accessible housing are immediately 18 available to individuals rebuilding their lives following the disaster. 19

• Partnering with Local aging agencies can ensure elders have access to 20 advocacy services that protect them from exploitation. 21

• Consulting architects who have expertise in Americans with Disabilities Act 22 standards can ensure reconstruction of destroyed municipal buildings will be fully 23 accessible for all members of the community. 24

25 The following sections present specific civil rights considerations related to individuals 26 with disabilities and individuals having limited English proficiency. 27 28 Individuals with Disabilities 29 30 The primary Federal non-discrimination legislation related to individuals with disabilities 31 includes: 32 33

• Rehabilitation Act of 1973, as amended 34 • Americans with Disabilities Act of 1990 35 • Fair Housing Act of 1968, as amended 36 • Architectural Barriers Act of 1968 37 • Communications Act of 1934, as amended 38 • Individuals with Disabilities Education Act (IDEA) of 1975, as amended 39

40 The above statutes require accessibility and prohibit discrimination against people with 41 disabilities in all aspects of emergency mitigation, planning, response, and recovery. To 42


comply with these laws, people responsible for notification protocols, evacuation and 1 emergency operations plans, shelter identification and operations, emergency medical 2 care facilities and operations, human services, and other emergency response and 3 recovery programs should: 4 5

• Have sound working knowledge of the accessibility and nondiscrimination 6 requirements applicable under Federal disability rights laws; 7

• Be familiar with the demographics of the population of people with disabilities 8 who live in their community; 9

• Involve people with different types of disabilities in identifying the communication 10 and transportation needs, accommodations, support systems, equipment, 11 services, and supplies that residents and visitors with disabilities will need during 12 an emergency; and 13

• Identify existing and develop new resources within the community that meet the 14 needs of residents and visitors with disabilities during emergencies. 15

16 The following are key nondiscrimination concepts applicable under Federal law and 17 examples of how these concepts apply to all phases of emergency management. 18 19

1. Self-Determination – People with disabilities are the most knowledgeable about 20 their own needs. 21

− Whenever choices are available, people with disabilities have the right to 22 choose their shelter location, what type of services they require, and who will 23 provide them. 24

2. No “One Size Fits All” – People with disabilities do not all require the same 25 assistance and do not all have the same needs. 26

− Many different types of disabilities affect people in different ways. 27 Preparations should be made for individuals with a variety of function-based 28 needs, including individuals who use mobility aids, require medication or 29 portable medical equipment, use service animals, need information in 30 alternate formats, or rely on a caregiver. 31

3. Equal Opportunity – People with disabilities should have the same opportunities 32 to benefit from emergency programs, services, and activities as people without 33 disabilities. 34

− Emergency recovery services and programs should be designed to provide 35 equivalent choices for people with disabilities as they do for individuals 36 without disabilities (including) choices about short-term housing or other 37 short- and long-term disaster support services. 38


4. Inclusion – People with disabilities have the right to participate in and receive the 1 benefits of emergency programs, services, and activities provided by 2 governments, private businesses, and nonprofit organizations. 3

− Inclusion of people with various types of disabilities in planning, training, and 4 evaluation of programs and services will ensure this population is given 5 appropriate consideration during emergencies. 6

5. Integration – Emergency programs, services, and activities typically should be 7 provided in an integrated setting. 8

− The provision of services such as sheltering, information intake for disaster 9 services, and short-term housing in integrated settings keeps individuals 10 connected to their support system and caregivers and avoids the need for 11 disparate service facilities. 12

6. Physical Access – Emergency programs, services, and activities should be 13 provided at locations that all people can access, including people with disabilities. 14

− People with disabilities should be able to enter and use emergency facilities 15 and access the programs, services, and activities that are provided. Facilities 16 typically required to be accessible include parking, drop-off areas, entrances 17 and exits, security screening areas, toilet rooms, bathing facilities, sleeping 18 areas, dining facilities, areas where medical care or human services are 19 provided, and paths of travel to and between these areas. 20

7. Equal Access – People with disabilities should be able to access and benefit 21 from emergency programs, services, and activities equal to the general 22 population. 23

− Equal access applies to emergency preparedness, notification of 24 emergencies, evacuation, transportation, communication, shelter, distribution 25 of supplies, food, first aid, medical care, housing, and application for and 26 distribution of benefits. 27

8. Effective Communication – People with disabilities should be given information 28 comparable in content and detail to that given to the general public, as well as 29 accessible, understandable, and timely. 30

− Auxiliary aids and services may be needed to ensure effective 31 communication. These may include pen and paper or sign language 32 interpreters through on-site or video interpreting for individuals who are deaf, 33 deaf-blind, hard of hearing or have speech impairments. Individuals who are 34 blind, deaf-blind, have low vision, or have cognitive disabilities may need 35 large print information or people to assist with reading and filling out forms. 36

9. Program Modifications – People with disabilities should have equal access to 37 emergency programs and services, which may entail modifications to rules, 38 policies, practices, and procedures. 39


− Service staff may need to change the way questions are asked, provide 1 reader assistance to complete forms, or provide assistance in a more 2 accessible location. 3

10. No Charge – People with disabilities may not be charged to cover the costs of 4 measures necessary to ensure equal access and nondiscriminatory treatment. 5

− Examples of accommodations provided without charge to the individual may 6 include ramps, cots modified to address disability-related needs, a visual 7 alarm, grab bars, additional storage space for medical equipment, lowered 8 counters or shelves, Braille and raised letter signage, a sign language 9 interpreter, a message board, assistance in completing forms, or documents 10 in Braille, large print, or audio recording. 11

Resources 12

The U.S. Department of Homeland Security has several resources available to assist 13 emergency managers in planning and response efforts related to people with disabilities 14 and to ensure compliance with Federal civil rights laws: 15

• Individuals with Disabilities in Emergency Preparedness – Executive Order 16 13347 17 The Department of Homeland Security (DHS) Office for Civil Rights and Civil 18 Liberties oversees the implementation of Executive Order 13347, Individuals with 19 Disabilities in Emergency Preparedness, which was signed by President Bush in 20 July 2004. This Executive Order is designed to ensure the safety and security of 21 individuals with disabilities in all-hazard emergency and disaster situations. To 22 this end, the Executive Order created an Interagency Coordinating Council (ICC) 23 on Emergency Preparedness and Individuals with Disabilities. The ICC 24 comprises senior leadership from more than 20 Federal departments and 25 agencies. Its mission is to ensure people with disabilities and their specific 26 needs are fully integrated into all aspects of our nation's emergency management 27 system, including mitigation, preparedness, response, and recovery. The 28 Secretary of Homeland Security is the Chair of the ICC, and he has delegated 29 that role to the DHS Officer for Civil Rights and Civil Liberties. The Executive 30 Order may be found at 31 http://www.whitehouse.gov/news/releases/2004/07/20040722-10.html 32

• Nationwide Plan Review Phase 2 Report 33 In June 2006, DHS, in cooperation with the U.S. Department of Transportation, 34 released the Nationwide Plan Review Phase 2 Report, including an assessment 35 of the degree to which state and urban areas integrate disability-related issues 36 into their emergency planning. The DHS Office for Civil Rights and Civil Liberties 37 disability specific review revealed major fragmentation, inconsistencies, and 38 critical gaps throughout the plans. Few plans demonstrated in-depth planning 39 and proactive thinking in preparing to meet the needs of people with disabilities 40 before, during, and after emergencies. Most plans delegated critical 41


responsibilities to third parties or other governmental entities without adequate 1 coordination, oversight, or assurance of resources. Most plans contain no 2 indication that a delegated function will be executed in a timely and effective 3 manner. Nearly 29 percent of American families include at least one person with 4 a disability according to the 2000 U.S. Census. Because family members, 5 caregivers, and/or dependents of people with disabilities feel they cannot or they 6 do not want to be separated during a disaster, there are a substantial number of 7 Americans affected by inadequate disability-related emergency planning.” 8

The Nationwide Plan Review also noted significant problems in the majority of 9 States such as limited numbers of medical personnel, inadequate capabilities to 10 track patients, weaknesses in evacuation planning, and a lack of functional 11 annexes that address special needs populations. The report is available at 12 https://www.dhs.gov/xlibrary/assets/Prep_NationwidePlanReview.pdf or in HTML 13 version at 14 http://64.233.167.104/search?q=cache:_qqM5L9j0fUJ:https://www.dhs.gov/xlibra15 ry/assets/Prep_NationwidePlanReview.pdf+Nationwide+Plan+Review+Phase+2+16 Report&hl=en&ct=clnk&cd=1&gl=us 17

• Guidelines for Accommodating Individuals with Disabilities in Disaster 18 The guidelines synthesize the array of existing accessibility requirements into a 19 user friendly tool for use by response and recovery personnel in the field. The 20 Guidelines are available at http://www.fema.gov/oer/reference/. 21

• Disability and Emergency Preparedness Resource Center 22 A Web-based “Resource Center” that includes dozens of technical assistance 23 materials to assist emergency managers in planning and response efforts related to 24 people with disabilities. The Resource Center, is available at 25 http://www.disabilitypreparedness.gov. 26

• Lessons Learned Information Sharing (LLIS) 27 A resource for planners at all levels of government, non-governmental organizations, 28 and private-sector entities, the resource page on Emergency Planning for Persons 29 with Disabilities and Special Needs provides more than 250 documents, including 30 lessons learned, plans, procedures, policies, and guidance, on how to include 31 citizens with disabilities and other special needs in all phases of the emergency 32 management cycle. 33

LLIS.gov is available to emergency response providers and homeland security 34 officials from the Local, state, and federal levels. To access the resource page, 35 log onto www.LLIS.gov and click on Emergency Planning for Persons with 36 Disabilities and Special Needs under Featured Topics. After meeting the 37 eligibility requirements for accessing Lessons Learned Information Sharing, 38 individuals can request membership by registering online. 39

In addition, the U.S. Department of Justice, which has enforcement authority over the 40 Americans with Disabilities Act, has posted best practice guidance for State and Local 41


governments on emergency management and individuals with disabilities. The Best 1 Practice Toolkit is located at http://www.ada.gov/pcatoolkit/chap7emergencymgmt.htm. 2

Individuals with Limited English Proficiency (LEP) 3

Overview 4

The Federal Government and those receiving assistance from the Federal Government 5 must take reasonable steps to ensure limited English proficient (LEP) persons have 6 meaningful access to the programs, services, and information those entities provide. 7 This will require agencies to develop creative solutions to address the needs of this 8 ever-growing population of individuals whose primary language is not English. 9

Limited English Proficiency—LEP 10

Who is a Limited English Proficient Person? 11

Persons who do not speak English as their primary language and who have a limited 12 ability to read, speak, write, or understand English can be limited English proficient, or 13 “LEP.” These individuals may be entitled to language assistance with respect to a 14 particular type of service, benefit, or encounter. 15

Who Must Comply? 16 All programs and operations of entities that receive assistance from the Federal 17 Government (i.e., recipients), including: 18

• State agencies. 19

• Local agencies. 20

• Private and nonprofit entities. 21

• Subrecipients (entities that receive Federal funding from one of the recipients 22 listed above) also must comply. 23

Recipients of Federal financial assistance operating in jurisdictions in which English has 24 been declared the official language are subject to Federal nondiscrimination 25 requirements, including those applicable to the provision of federally assisted services 26 to persons who are LEP. 27

All programs and operations of the Federal Government also must comply. 28


Legal Authority 1

Recipients: 2 Title VI of the 1964 Civil Rights Act 3 “No person in the United States shall, on the ground of race, color or national origin, be 4 excluded from participation in, be denied the benefits of, or be subjected to 5 discrimination under any program or activity receiving federal financial assistance.” 6 —42 U.S.C. § 2000d. 7

Different treatment based on a person's inability to speak, read, write, or understand 8 English may be a type of national origin discrimination. 9 10 Recipients and Federal Government: 11 Executive Order 13166 12 This Order, “Improving Access to Services for Persons with Limited English 13 Proficiency,” directed federal agencies to: 14

o Publish guidance on how their recipients can provide access to LEP persons. 15 o Improve the language accessibility of their own Federal programs. 16 o Break down language barriers by implementing consistent standards of language 17

assistance across Federal agencies and amongst all recipients of Federal 18 financial assistance. 19

The Order covers all Federal and federally assisted programs and activities. 20

Obligations 21

Four-Factor Analysis 22 Recipients of Federal financial assistance have an obligation to reduce language 23 barriers that can preclude meaningful access by LEP persons to important benefits, 24 rights, programs, information, and services. (The Federal Government has the same 25 obligations as a result of Executive Order 13166.) The starting point is an individualized 26 assessment that balances the following four factors: 27

1. The number or proportion of LEP persons eligible to be served or likely to be 28 encountered by the program or grantee/recipient; 29

2. The frequency with which LEP individuals come in contact with the program; 30

3. The nature and importance of the program, activity, or service provided by the 31 program to people’s lives; and 32

4. The resources available to the grantee/recipient and costs. 33


Elements of an Effective LEP Policy 1 Elements that may be helpful in designing an LEP policy or plan: 2

• Identifying LEP persons who need language assistance 3 • Identifying ways in which language assistance will be provided 4 • Training staff 5 • Providing notice to LEP persons 6 • Monitoring and updating LEP policy 7

8 Examples of Language Assistance Services 9

• Direct foreign language communication by fluent bilingual staff 10 • Interpretation (oral), conducted in-person or via telephone by qualified 11

interpreters 12 • Translation (written) by qualified translators 13

14 Resources 15 16 General LEP information: www.LEP.gov 17

• This site acts as a clearinghouse, providing and linking to information, tools, and 18 technical assistance regarding Limited English Proficiency and language services 19 for Federal agencies, recipients of Federal funds, users of Federal programs and 20 federally assisted programs, and other stakeholders. 21

22 National Association of Judicial Interpreters and Translators, Disaster Assistance 23 Information: http://www.najit.org/DisasterRelief.html 24 25 Department of Justice LEP Guidance Document for Recipients of Federal Financial 26 Assistance: http://www.usdoj.gov/crt/cor/lep/DOJFinLEPFRJun182002.pdf 27 28 Health and Human Services LEP Guidance Document for Recipients of Federal 29 Financial Assistance: http://www.usdoj.gov/crt/cor/lep/hhsrevisedlepguidance.pdf 30 31 Chapter 1 of Department of Justice’s “Executive Order 13166 Limited English 32 Proficiency Resource Document: Tips and Tools from the Field:” 33 http://www.lep.gov/lepdoc%20chapter1.htm 34 35


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20



APPENDIX G – GLOSSARY 1

2 Accessible. Having the legally required features and/or qualities that ensure entrance, 3 participation, and usability of places, programs, services, and activities by individuals 4 with a wide variety of disabilities. 5 6 Agency. A division of government with a specific function offering a particular kind of 7 assistance. In the Incident Command System, agencies are defined either as 8 jurisdictional (having statutory responsibility for incident management) or as assisting or 9 cooperating (providing resources or other assistance). Governmental organizations are 10 most often in charge of an incident, though in certain circumstances private-sector 11 organizations may be included. Additionally, nongovernmental organizations may be 12 included to provide support. 13 14 Centers for Independent Living (CILs). Community-based, non-residential 15 organizations that help create opportunities for, and eliminate discrimination against, 16 people with disabilities. 17 18 Children. Encompasses individuals from birth through age 18, covering the entire 19 spectrum of developmental stages. 20 21 Citizen Corps. Administered by the Department of Homeland Security/Federal 22 Emergency Management Agency, Citizen Corps brings government and community 23 members and organizations together to involve community members in all-hazards 24 emergency preparedness, planning, mitigation, response and recovery. Citizen Corps 25 includes a network of local, State, and Tribal Councils, which increase community 26 preparedness and response capabilities through public education, outreach, training, 27 and volunteer service. 28 29 Closed Captioning. The display of text coinciding with the audio portion of a television 30 broadcast that allows persons with hearing disabilities to have access to these 31 broadcasts. 32 33 Disability (individual with). A person who has a physical or mental impairment that 34 substantially limits one or more major life activities, a person who has a history or record 35 of such an impairment, or a person who is perceived by others as having such an 36 impairment. 37 38 Durable Medical Equipment. Certain medical equipment for use in the home, such as 39 walkers or wheelchairs. 40 41 Emergency. Any incident, whether natural or manmade, that requires responsive action 42 to protect life or property. Under the Robert T. Stafford Disaster Relief and Emergency 43 Assistance Act, an emergency means any occasion or instance for which, in the 44


determination of the President, Federal assistance is needed to supplement State and 1 Local efforts and capabilities to save lives and to protect property and public health and 2 safety, or to lessen or avert the threat of a catastrophe in any part of the United States. 3 4 Emergency Operations Plan (EOP). The ongoing plan maintained by various 5 jurisdictional levels for responding to a wide variety of potential hazards. 6 7 Emergency Public Information. Information that is disseminated primarily in 8 anticipation of an emergency or during an emergency. In addition to providing 9 situational information to the public, it also frequently provides directive actions required 10 to be taken by the general public. 11 12 Emergency Support Function (ESF) Annexes. Present the missions, policies, 13 structures, and responsibilities of Federal agencies for coordinating resource and 14 programmatic support to States, tribes, and other Federal agencies or other jurisdictions 15 and entities when activated to provide coordinated Federal support during an incident. 16 17 Federal. Of or pertaining to the Federal Government of the United States of America. 18 19 Geographic Information System (GIS). A system for capturing, storing, analyzing and 20 managing data and associated attributes which are spatially referenced to the earth. In 21 the strictest sense, it is a computer system capable of integrating, storing, editing, 22 analyzing, sharing, and displaying geographically-referenced information. 23 24 Limited English Proficiency. Persons who do not speak English as their primary 25 language and who have a limited ability to read, speak, write, or understand English. 26 These individuals may be entitled to language assistance with respect to a particular 27 type of service, benefit, or encounter. 28 29 Local Government. A county, municipality, city, town, township, Local public authority, 30 school district, special district, intrastate district, council of governments (regardless of 31 whether the council of governments is incorporated as a nonprofit corporation under 32 State law), regional or interstate government entity, or agency or instrumentality of a 33 Local government; an Indian tribe or authorized Tribal entity, or in Alaska a Native 34 Village or Alaska Regional Native Corporation; a rural community, unincorporated town 35 or village, or other public entity. See Section 2 (10), Homeland Security Act of 2002, 36 P.L. 107−296, 116 Stat. 2135 (2002). 37 thereby. 38 Mitigation. Activities providing a critical foundation in the effort to reduce the loss of life 39 and property from natural and/or manmade disasters by avoiding or lessening the 40 impact of a disaster and providing value to the public by creating safer communities. 41 Mitigation seeks to fix the cycle of disaster damage, reconstruction, and repeated 42 damage. These activities or actions, in most cases, will have a long-term sustained 43 effect. 44 45


Mutual Aid and Assistance Agreement. Written or oral agreement between and 1 among agencies/organizations and/or jurisdictions that provides a mechanism to quickly 2 obtain emergency assistance in the form of personnel, equipment, materials, and other 3 associated services. The primary objective is to facilitate rapid, short-term deployment 4 of emergency support prior to, during, and/or after an incident. 5 6 National. Of a nationwide character, including the Federal, State, Local, and Tribal 7 aspects of governance and policy. 8 9 National Incident Management System (NIMS). System that provides a proactive 10 approach guiding government agencies at all levels, the private sector, and 11 nongovernmental organizations to work seamlessly to prepare for, prevent, respond to, 12 recover from, and mitigate the effects of incidents, regardless of cause, size, location, or 13 complexity, in order to reduce the loss of life or property and harm to the environment, 14 supporting technologies, and the maintenance for these systems over time. 15 16 National Response Framework (NRF). Guides how the Nation conducts all-hazards 17 response. The Framework documents the key response principles, roles, and structures 18 that organize national response. It describes how communities, States, the Federal 19 Government, and private-sector and nongovernmental partners apply these principles 20 for a coordinated, effective national response. And it describes special circumstances 21 where the Federal Government exercises a larger role, including incidents where 22 Federal interests are involved and catastrophic incidents where a State would require 23 significant support. It allows first responders, decisionmakers, and supporting entities to 24 provide a unified national response. 25 26 Nongovernmental Organization (NGO). An entity with an association that is based on 27 interests of its members, individuals, or institutions. It is not created by a government, 28 but it may work cooperatively with government. Such organizations serve a public 29 purpose, not a private benefit. Examples of NGOs include faith-based charity 30 organizations and the American Red Cross. NGOs, including voluntary and faith-based 31 groups, provide relief services to sustain life, reduce physical and emotional distress, 32 and promote the recovery of disaster victims. Often these groups provide specialized 33 services that help individuals with disabilities. NGOs and voluntary organizations play a 34 major role in assisting emergency managers before, during, and after an emergency. 35 36 National Voluntary Organizations Active in Disaster (National VOAD). A 37 consortium of more than 30 recognized national organizations active in disaster relief. 38 Their organizations provide capabilities to incident management and response efforts at 39 all levels. During major incidents, National VOAD typically sends representatives to the 40 National Response Coordination Center to represent the voluntary organizations and 41 assist in response coordination. 42 43 Paratransit. The family of transportation services which falls between the single 44 occupant automobile and fixed route transit. Examples of paratransit include taxis, 45


carpools, vanpools, minibuses, jitneys, demand responsive bus services, and 1 specialized bus services for the mobility impaired or transportation disadvantaged. 2 3 Preparedness. Actions that involve a combination of planning, resources, training, 4 exercising, and organizing to build, sustain, and improve operational capabilities. 5 Preparedness is the process of identifying the personnel, training, and equipment 6 needed for a wide range of potential incidents, and developing jurisdiction-specific plans 7 for delivering capabilities when needed for an incident. 8 9 Private Sector. Organizations and entities that are not part of any governmental 10 structure. The private sector includes for-profit and not-for-profit organizations, formal 11 and informal structures, commerce, and industry. 12 13 Reasonable Accommodation/Reasonable Modification. In general, an 14 accommodation is any change to the rules, policies, procedures, environment or in the 15 way things are customarily done that enables an individual with a disability to enjoy 16 greater participation. A requested accommodation is unreasonable if it poses an undue 17 financial or administrative burden or a fundamental alteration in the program or service. 18 19 Recipients of Federal Financial Assistance. All types of entities that receive Federal 20 financial assistance, regardless of whether they are a governmental agency, a private 21 organization, or a religious entity. 22 23 Recovery. The development, coordination, and execution of service- and site-24 restoration plans; the reconstitution of government operations and services; individual, 25 private-sector, nongovernmental, and public-assistance programs to provide housing 26 and to promote restoration; long-term care and treatment of affected persons; additional 27 measures for social, political, environmental, and economic restoration; evaluation of 28 the incident to identify lessons learned; post-incident reporting; and development of 29 initiatives to mitigate the effects of future incidents. 30 31 Religious Entity. A religious organization, including a place of worship. 32 33 Resources. Personnel and major items of equipment, supplies, and facilities available 34 or potentially available for assignment to incident operations and for which status is 35 maintained. Under the National Incident Management System, resources are described 36 by kind and type and may be used in operational support or supervisory capacities at an 37 incident or at an emergency operations center. 38 39 Response. Activities that address the short term, direct effects of an incident. 40 Response includes immediate actions to save lives, protect property, and meet basic 41 human needs. Response also includes the execution of EOPs and of mitigation 42 activities designed to limit the loss of life, personal injury, property damage, and other 43 unfavorable outcomes. As indicated by the situation, response activities include 44 applying intelligence and other information to lessen the effects or consequences of an 45 incident; increased security operations; continuing investigations into nature and source 46


of the threat; ongoing public health and agricultural surveillance and testing processes; 1 immunizations, isolation, or quarantine; and specific law enforcement operations aimed 2 at preempting, interdicting, or disrupting illegal activity, and apprehending actual 3 perpetrators and bringing them to justice. 4 5 Service Animal. The ADA defines “service animal” as any “guide dog, signal dog, or 6 other animal individually trained to provide assistance to an individual with a disability.” 7 8 Sign Language Interpreter. A person who has been trained to use a system of 9 conventional symbols or gestures made with the hands and body to help people who 10 are deaf, are hard of hearing, or have speech impairments communicate. 11 12 Special Needs Populations. Populations whose members may have additional needs 13 before, during, and after an incident in functional areas, including but not limited to: 14 maintaining independence, communication, transportation, supervision, and medical 15 care. Individuals in need of additional response assistance may include those who have 16 disabilities; who live in institutionalized settings; who are elderly; who are children; who 17 are from diverse cultures; who have limited English proficiency or are non-English 18 speaking; or who are transportation disadvantaged. 19 20 State. When capitalized, refers to any State of the United States, the District of 21 Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American 22 Samoa, the Commonwealth of the Northern Mariana Islands, and any possession of the 23 United States. See Section 2 (14), Homeland Security Act of 2002, Public Law 107-24 296, 116 Stat. 2135 (2002). 25 26 Telecommunications. The transmission, emission, or reception of voice and/or data 27 through any medium by wire, radio, other electrical electromagnetic or optical means. 28 Telecommunications includes all aspects of transmitting information. 29 30 Telecommunications Relay Service (TRS). A telephone service that uses operators, 31 called communications assistants (CAs), to facilitate telephone calls between people 32 with hearing and speech disabilities and other individuals. TRS providers—generally 33 telephone companies—are compensated for the costs of providing TRS from either a 34 state or a federal fund. There is no cost to the user. 35 36 Telecommunications Service Priority (TSP) Program. The National 37 Security/Emergency Preparedness (NS/EP) TSP program is the regulatory, 38 administrative, and operational program authorizing and providing for priority treatment 39 (i.e., provisioning and restoration) of NS/EP telecommunications services. As such, it 40 establishes the framework for NS/EP telecommunications service vendors to provide, 41 restore, or otherwise act on a priority basis to ensure effective NS/EP 42 telecommunications services. 43 44 Tribal. Referring to any Indian tribe, band, nation, or other organized group or 45 community, including any Alaskan Native Village as defined in or established pursuant 46


to the Alaskan Native Claims Settlement Act (85 Stat. 688) [43 U.S.C.A. and 1601 et 1 seq.], that is recognized as eligible for the special programs and services provided by 2 the United States to Indians because of their status as Indians. 3 4 Video Relay. Form of Telecommunications Relay Service that enables people who are 5 deaf, are hard of hearing, or have speech disabilities who use American Sign Language 6 (ASL) to communicate with voice telephone users through video equipment, rather than 7 through typed text. 8 9 Voluntary Agency. Any chartered or otherwise duly recognized tax-exempt Local, 10 State, or national organization or group that has provided or may provide needed 11 services to the States, Local governments, or individuals in coping with an emergency 12 or a major disaster. 13 14

CPG-301 EM Planning Guide for Special Needs Populations ......4 INTERIM - Comprehensive Preparedness Guide 301 August 2008 1 III. DEFINING “SPECIAL 2 NEEDS” 3 4 Emergency management

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